UMASS/AMHERST 


797 
vM4 


^» 


**« 

TftA  '  •  "J 

s?? 

$#jj 

L^BLaA&j 

Ft: 

5P|^ 

Mi 

tf£ 

B*^bG> 

St- 

r! 

LIBRARY 


OF  THE 


MASSACHUSETTS 

AGRICULTURAL 

COLLEGE 


NO.-.         sr 
SOUR         797 


ATE.J0-1SU. 
!§£ 


V- 


RABIES-HYDROPHOBIA. 


BY  THEODORE  R.  MAC  OLORE,  LANSING,  MICHIGAN. 


[Reprinted  from  the  Proceedings  of  the  Sanitary  Convention  at  Charlotte,  Michigan,  Nov.  22  and  23, 

1894,  published  as  a  Supplement  to  the  Annual  Report  of   the  Michigan 

State  Board  of  Health  for  the  year  1895.] 


[Rephint  No.  433.1 


U  19.3  1 

H  <rw 

RABIES-HYDROPHOBIA. 


By  Theodoee  R.  MaoCluee,  Lansing,  Michigan. 


INTRODUCTION. 


Rabies  is  a  disease  common  to  both  man  and  animals,  and  can  be  classed 
with  the  diseases  dangerous  to  the  public  health.  Rabies  in  man  may 
be  attended  with  one  symptom  which  is  spoken  of  as  "  fear  of  water"  from 
which  the  term  hydrophobia  originates,  but  really  there  is  no  great  differ- 
ence between  the  rabies  of  man  and  the  rabies  of  animals.  Water  and 
other  liquids  or  even  a  draft  of  air  from  a  window  or  from  a  fan  may  cause 
the  spasm  or  convulsion.  The  spasm  caused  by  water  has  led  to  the  term 
hydrophobia.  Many  writers  seem  to  favor  using  the  term  hydrophobia 
when  speaking  of  rabies  in  man,  and  rabies  when  speaking  of  the  disease 
in  animals,  although  technically  speaking  there  is  no  such  disease  as 
hydrophobia.  It  seems,  however,  to  be  a  convenient  usage  of  terms;  and 
I  may  in  the  pages  following  use  the  term  hydrophobia  when  speaking  of 
rabies  in  man  and  rabies  when  referring  to  the  disease  in  animals. 

Through  my  work  in  the  office  of  the  State  Board  of  Health,  in  giving 
attention  to  the  reports  of  alleged  outbreaks  of  rabies  and  cases  of  hydro- 
phobia, I  have  become  much  interested  in  the  subject.  The  disease  does 
not  cause  three  thousand  deaths  in  man  in  Michigan  every  year,  as  does 
consumption,  nor  does  it  cause  such  great  mortality  in  the  human  race 
every  year  as  does  diphtheria,  scarlet  fever,  typhoid  fever  or  measles,  but 
I  presume  there  is  no  disease  to  which  the  human  race  is  heir  that  causes 
more  fear  or  consternation  than  does  a  case  of  hydrophobia  or  rabies. 
Many  people  think  that  small-pox  is  a  dreadful  disease  and  causes  many 
deaths,  but  I  presume  that  a  yearly  average  for  the  last  ten  years  will 
show  that  there  have  been  in  Michigan  not  many  more  deaths  from  small- 
pox than  from  hydrophobia.  Neither  small-pox  nor  hydrophobia  is  as 
frequent  as  it  was  many  years  ago,  when  preventive  medicine  was  not 
known.  In  1780  Jenner  discovered  preventive  vaccination  against  small- 
pox, and  in  1885  Louis  Pasteur  discovered  the  preventive  treatment 
against  hydrophobia  and  rabies,  and  to-day  millions  of  people  are  being 
vaccinated  every  year  to  protect  themselves  against  an  attack  of  small-pox, 
and  thousands  of  people  having  been  bitten  by  dogs  or  other  animals 
known  or  supposed  to  have  been  mad,  have  received  treatment  which  has 
generally  insured  them  against  the  development  of  that  fearful  disease — 
hydrophobia. 

*  This  paper  was  not  read  (except  by  titie) ;  bat  an  outline  of  the  paper  was  placed  before  the  Execu- 
tive Committee  of  the  Conveatiou,  and  members  of  the  State  Board  of  Health  and  it  was  unanimously 
voted  that  the  paper  should  be  printed  in  the  pamphlet  proceedings  of  the  Convention. 

Note.— In  the  preparation  of  this  paper,  especially  that  portion  relating  to  Etiology,  I  am  indebted  to 
the  kind  assistance  of  Dootoe  Geobge  H.  Cattebmole,  of  Lansing. 


RABIES— HYDROPHOBIA.  19 

I  am  sorry  that  I  am  not  in  a  position  to  give  the  results  of  some  original 
researches  as  are  most  of  the  persons  who  attempt  to  write  on  this  subject; 
but,  as  that  is  one  of  the  impossibilities,  I  will  endeavor  to  reiterate  only 
what  has  probably  already  been  said.  My  object  in  writing  this  paper  is 
to  place  before  the  people  some  facts  which  may  be  of  interest  to  them 
and  may  directly  or  indirectly  be  the  means  of  saving  some  human  lives, 
because  it  does  not  seem  to  me  that  there  is  any  necessity  for  persons  bit- 
ten by  rabid  animals  to  suffer  the  agonies  which  are  attended  with  death 
from  that  terrible  disease. 

EARLY   HISTORY. 

Rabies  has  existed  for  many  centuries;  and,  as  the  disease  may  occur  in 
almost  any  warm-blooded  animal,  it  is  not  at  all  improbable  that  there  may 
have  been  cases  of  rabies  soon  after  the  creation  of  animals  as  mentioned 
in  the  first  book  of  the  Bible.  As  the  disease  most  frequently  occurs  in 
dogs,  I  presume  that  history  would  record  cases  as  early  as  1,500  years 
before  Christ,  for  about  that  time  dogs  were  mentioned  by  Moses,  and 
about  32,  Anno  Domini,  dogs  were  spoken  of  as  "  eating  the  crumbs  which 
fall  from  their  master's  table." 

The  early  history  of  canine  rabies  is  somewhat  obscure,  but,  whenever 
spoken  of  by  the  early  writers,  it  seems  to  be  dreaded  as  much  as  at  this 
period.  Plutarch  says  that  hydrophobia  was  first  observed  in  the  days 
of  Asclepias,  the  God  of  Medicine.  Aristotle  spoke  of  canine  rabies, 
but  thought  the  disease  was  never  communicated  to  the  human  race. 
Celsus  gave  the  subject  especial  attention  and  believed  that,  on  account  of 
a  morbific  virus,  the  bite  of  all  animals  was  dangerous.  Ovid  states  that 
hydrophobia  and  gout  were  in  his  day  reckoned  among  the  incurable  dis- 
eases. During  the  first  centuries  of  the  Christian  era  considerable  atten- 
tion was  given  to  the  causation  and  treatment  of  hydrophobia.  Many 
different  theories  as  to  its  causation  were  advanced,  but  Pedanius  Diosco- 
rides  was  probably  about  the  first  (in  the  fourth  or  fifth  century,  Anno 
Domini)  to  give  an  exact  description  of  the  disease.  In  his  work  on 
"  Materia  Medica  "  he  mentioned  its  tranmissibility  from  animals  to  man- 
kind, its  certain  fatalitv  when  once  developed,  and  its  prevention  by  cau- 
terization. But  up  to  the  eighteenth  century  there  was  little  progress 
made  in  ascertaining  the  nature  and  causation  of  rabies  or  hydrophobia 
and  their  restriction  and  prevention. 

As  early  as  900,  Anno  Domini,  outbreaks  of  rabies  were  recorded. 
"  One  day  a  mad  bear,  following  the  course  of  the  river  Saone,  at  last 
reached  the  quay  at  Lyons.  Everybody  fled  at  its  approach,  except  some 
boatmen  who,  armed  with  heavy  sticks,  attempted  to  kill  it.  The  bear, 
however,  little  intimidated  by  their  number,  rushed  amongst  them  and  bit 
many — about  twenty.  Of  this  party  six  were  smothered  in  about  twenty- 
seven  days  on  account  of  fearful  madness.  The  other  fourteen,  however, 
had  thrown  themselves  into  the  river  to  escape  the  animal's  attacks,  and 
having  to  swim  to  the  opposite  bank,  where  thus  preserved  from  the  effects 
of  the  poison;  the  water  of  the  river  had  saved  them,  for  in  beating  against 
their  wounds,  it  had  washed  away  the  venom."  *  In  the  sixteenth  century, 
according  to  Fleming,  rabies  was  reported  in  Spain,  Flanders,  Turkey, 
Hungary,  Austria,  et  cetera,  and  in  Hungary  in  1 712  wild  beasts  of  all 
kinds  went  mad,  as  did  also  many  persons,  and  in  England  many  dogs  went 
mad  and  bit  many  people.     "  In  1768  rabies  was  alarmingly  frequent  in 

*  Fleming's  "  Animal  Plagues,"  1871,  page  51. 


20  CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 

Boston  and  other  towns  of  North  America,"  and  a  few^years  later  in  Boston 
and  vicinity  rabies  was  present  in  dogs  and  foxes,  and  swine  were  the 
principal  victims  of  the  animals'  rage. 

It  is  useless  to  cite  further  outbreaks  of  rabies  and  hydrophobia,  for 
during  the  fifteenth  and  sixteenth  centuries  and  up  to  the  present  time 
history  is  prolific  with  outbreaks  of  the  disease  in  animals  and  in  man. 
One  has  but  to  read  Fleming's  work  on  "  Rabies  and  Hydrophobia  "  to 
become  thoroughly  convinced  that  these  diseases  were  frequent  and  wide- 
spread, causing  great  destruction  of  property  and  human  lives. 

ETIOLOGY. 

Some  observers  have  thought  that  rabies  might  occur  spontaneously  in 
animals  but  I  think  there  is  not  now  much  question  but  that  most,  if  not 
all,  the  rabies  comes  from  a  previous  case  and  is  due  to  a  specific  poison 
which  has  been  inoculated  into  the  animal,  generally  by  the  bite  of 
another  animal.  It  has  been  claimed  that  certain  conditions  either 
directly  or  indirectly  were  the  cause  of  the  disease,  but  the  recognized 
authorities  now  believe  that  neither  climate,  season,  sex,  age,  etc.,  cause 
the  disease,  although  they  may  have  modifying  influences. 

We  now  know  that  the  disease  arises  from  the  inoculation  of  the  specific 
virus  which  seems  to  be  more  abundant  in  the  saliva  than  any  other  secre- 
tion of  the  body.  Boll,  Fleming  and  others  believe  the  poison  is  present 
in  the  blood  and  consequently  in  all  parts  of  the  body,  but  other  authori- 
ties have  failed  to  cause  rabies  by  inoculation  of  the  blood  of  rabic  ani- 
mals. M.  Galtier  has  shown  that  the  saliva  of  animals  dead  of  rabies  or 
killed  after  having  developed  the  disease  does  not  lose  its  virulence  for 
some  time  after  death.  Animals  inoculated  with  the  fresh  saliva,  blood, 
et  cetera,  do  not  always  contract  the  disease,  on  account  of  some  animals 
being  less  susceptible  than  others.  Fleming  says  that  "dogs  and  cats  hold 
the  first  place  in  the  scale  of  susceptibility;  then  man  and  pigs;  next 
ruminants,  the  sheep  and  the  goat  being  more  susceptible  than  the  ox,  and 
lastly  the  horse."  Renault  inoculated  ninety-nine  animals  (horses,  dogs 
and  sheep)  and  only  sixty-seven  were  affected  with  the  disease.  Roll  says 
that  successful  inoculations  vary  from  twenty-four  to  seventy  per  cent., 
whilst  from  the  bite  of  dogs  it  varies  from  twenty  to  seventy  per  cent., 
showing  that  the  disease  is  less  liable  to  be  produced  by  the  bite  of  a 
rabid  animal  than  from  experimental  inoculation,  which  can  probably  be 
attributed  to  the  fact  that  experimental  inoculation  occurs  under  different 
conditions  than  does  the  bite,  and  that  their  hair,  et  cetera,  protect  the 
animals  somewhat  from  the  introduction  of  the  specific  virus.  Then, 
again,  it  is  not  so  sure  that  the  poison  is  really  inoculated  by  a  bite  as  by 
experimental  inoculation. 

The  etiology  of  rabies  is  still  questioned,*  but  many  of  those  who  at 
first  doubted  its  specific  character,  and  its  transmission  by  inoculation, 
have,  on  continuing  their  experiments  and  improving  their  methods  of 
operation,  come  to  conclusions  almost  identical  with  those  of  Pasteur  and 
his  school,  f  Among  the  class  of  writers,  who  draw  their  conclusions  from 
experimentation,  there  is  a  consensus  of  opinion  that  the  disease  is  due  to 
inoculation  with  virus  containing  the  specific  cause  of  the  disease. 

*  Dulles:  The  Medical  Record,  1877,  page  672 ;  The  Medical  News,  1894,  pages  653—655.  Stookwell 
Brill,  Spitzka,  Johne;    Jahresbericht,  1889.    Von  Friech,  Vienna. 

t  Peofessob  A.  Hogyes:  "  Die  Experimental  Basis  der  Antirabischen  Schutzimpfangen  Pasteur's," 
Stuttgart,  1889. 


RABIES— HYDROPHOBIA.  21 

Dana  says: — "  In  order  to  prove  that  a  certain  disease  is  autonomous,  dis- 
tinct and  special  we  must  establish  the  fact  that  its  etiology  and  its  clinical 
history  are  essentially  uniform,  or  that  the  anatomical  changes  found  after 
death  are  the  same,  or  that  inoculations  of  animals  with  the  secretions  or 
tissues  of  the  victims  of  the  disease  reproduce  the  disease." 

With  regard  to  his  first  requirement — uniform  etiology — there  is  not  a 
case  on  record  where  rabies  appeared  in  an  animal  without  its  having  been 
inoculated  with  material  from  another  animal  which  is  suffering  from  the 
same  disease.  Usually  the  infection  in  man  can  be  traced  directly  to  ani- 
mals suspected  from  their  actions,  of  having  rabies,  but  in  some  cases  the 
injury  is  considered  as  a  simple  abrasion  until  the  characteristic  symptoms 
appear.* 

Doctor  Paul  Gibier  states,  in  a  letter  to  me,  that — "  The  disease  may  be 
communicated  by  a  rabid  dog  licking  the  bare  part  of  a  person's  skin  on 
which  some  slight  abrasion  exists."f 

As  to  the  second  of  Dana's  requirements — a  uniformity  in  the  clinical 
history — while  the  symptoms  vary  some  in  different  animals,  they  are  very 
uniform  for  any  certain  species,  as  the  extended  irritative  period  (furious 
rabies)  in  the  dog,  and  the  more  marked  stage  of  paralysis  in  the  rabbit. 

There  are  many  good  reasons  for  believing  that  rabies  is  due  to  micro- 
organisms, whether  a  single  species  or  not,  we  cannot  say;  different  inves- 
tigators find  different  microscopic  forms  present  in  the  victims  of  the  dis- 
ease (as  Fol's  micrococcus,  Babes'  bacillus,  et  cetera,  andGiBiER's  micro- 
coccus),! and  the  symptoms  vary  enough  to  make  a  mixed  infection 
possible. 

There  is  strong  evidence  in  favor  of  the  belief  that  rabies  is  due  to  some 
biological  factor  or  living  cause;  this  may  be  a  bacterium,  or  one  of  the 
lower  animal  forms,  as  protozoa,  coccidia,  or  psorosperm.  Considering  the 
period  of  incubation,  the  fact  that  minute  quantities  when  inoculated  »will 
cause  the  disease,  and  the  ease  with  which  the  virus  is  rendered  inert, 
by  means  which,  while  sufficient  to  destroy  low  forms  of  living  organisms, 
do  not  change  the  chemical  products  contained  therein,  we  see  at  once  the 
resemblance  between  the  properties  and  action  of  this  virus  and  that  of 
other  diseases  which  are  known  to  be  due  to  microorganisms,  and  it  is  evi- 
dent from  the  following  facts,  that  the  causal  agent  is  something  capable 
of  reproduction  and  growth,  and  not  a  chemical  poison  contained  in  the 
inoculating  virus:  (a)  filtration  removes  the  virulent  matter  from  the 
emulsion;  (b)  a  longer  or  shorter  period  occurs,  between  the  inoculation 
and  the  onset  of  the  disease,  in  which  time  (period  of  incubation)  the 
cause,  if  a  biological  one,  has  an  opportunity  of  increasing;  and  (c)  the 
exposure  of  rabic  virus  for  one  hour  to  a  temperature  of  50°  centigrade 
(122°  Fahrenheit),  or  to  desiccation  and  direct  sunlight  for  three  hours 
will  destroy  the  virulence,  and  exposure  to  a  one  per  cent,  carbolic  acid 
solution,  or  to  a  one-tenth  per  cent,  corrosive  sublimate  solution,  for  three 
hours,  renders  the  virus  inert. § 

Pasteur,  Roux,  Chambebland  and  others  made  careful  search  for  micro- 
organisms in  the  various  tissues  of  animals  affected  with  rabies;  small 

*  "American  Reference  Hand-Book  of  Medical  Science,"  Volume  VI.  Raffer:  The  British  Medical 
Journal,  Volume  II,  1889,  page  687. 

t  Weloh  on  "  Hydrophobia"—"  Transactions  of  the  Maryland  Medical  and  Chirurgical  Faculty,"  1889. 

In  the  Annals  de  V Institute  Pasteur,  1889,  was  published  an  account  of  the  cases  of  Pierre  Butt  and  his 
wife,  who  were  licked  on  open  wounds  by  a  rabid  dog.  Butt  was  given  antirabic  treatment  and  did  not 
have  rabies;  his  wife  declined  treatment  and  died  of  the  disease. 

%  Sternberg's  "Manual  of  Bacteriology,"  1892,  page  522. 

§  Biggs:  "  Transactions  of  the  New  York  Academy  of  Medicine,"  1891.  Welch:  "  Transactions  of  the 
Maryland  Medical  and  Chirurgical  Faculty,"  1889. 


22  CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 

bodies  were  seen  in  the  medulla  which  were  thought  to  be  micrococci,  but 
later  these  were  considered  as  having  little  or  no  relation  to  the  disease. 
In  1884  Gibier  described  his  observations  of  supposed  micrococci  in  the 
medulla  of  animals  dead  of  rabies.*  In  1885  Fol  was  able  to  demonstrate 
small  granules  resembling  micrococci  in  the  lymph  spaces  of  the  cord 
taken  from  animals  which  had  died  of  this  disease;  thin  sections  of  the 
cord  were  stained  after  Wiegert's  method,  with  a  solution  of  hematoxy- 
line.  Babes  f  describes  his  observations  of  organisms  resembling  micro- 
cocci in  the  brain  and  cord  of  animals  suffering  from  rabies,  which  are 
stained  a  rose  color  by  Loeffler's  alkaline  methylene  blue  solution.  He 
has  succeeded  in  making  cultures  of  this  germ,  which  will  cause  symptoms 
of  rabiep  when  injected  into  animals,  but  not  in  all  cases. 

Curve-shaped  bacilli  and  spindle-shaped  bacilli  are  described  as  being 
present  in  the  brains  of  animals,  and  thick,  curved  motile  bacilli  are  said 
to  be  found  in  the  blood  of  rabbits  during  the  stage  of  fever.  J 

In  the  opinion  of  Sternberg  death  is  caused  in  cases  of  rabies  by  the 
action  of  a  potent  chemical  poison  of  the  class  of  toxalbumins,  which  is 
possibly  the  same  as  the  substance  which  Pasteur  calls  mati&re  vaccinale 
contained  in  the  emulsion  used  in  the  antirabic  treatment  and  supposed  by 
him  to  produce  the  immunity.  He  says  it  is  contained  in  the  inoculating 
material,  but  is  not  identical  with  the  microorganism  causing  rabies. 

It  has  been  found  by  experimentation  that  if  large  doses  of  the  strong 
virus  are  injected  into  the  subcutaneous  tissue  the  animal  is  less  likely  to 
contract  the  disease  than  when  a  small  amount  of  the  strong  virus  is  used. 
Ferran  requires  that  his  patients  agree  to  finish  the  treatment  before  he 
gives  them  the  first  inoculation,  because,  he  thinks  that  the  immunity  is  in 
proportion  to  the  amount  of  virulent  virus  used.  Bareggi  lost  five  patients 
by  using  the  superintensive  method,  which  misfortune  Ferran  attributes 
to  using  too  little  of  the  virus.  These  results  may  be  due  to  the  large 
amount  of  chemical  product  (toxalbumin)  contained  in  the  large  dose 
being  sufficient  to  prevent  the  growth  of  the  microorganisms,  or  the  poison 
may  so  stimulate  the  tissue  cells  that  they  are  able  to  cope  successfully 
with  the  living  matter  contained  in  the  emulsion. 

Pasteur  and  others,§  I  believe,  have  studied  the  action  of  these  chem- 
ical substances  found  in  the  emulsion,  et  cetera.  It  would  seem  possible 
in  reviewing  the  results  obtained  from  the  use  of  antitoxins  in  diphtheria, 
malignant  edema,  anthrax,  et  cetera,  that  the  use  of  the  sterilized  emul- 
sion of  rabic  medulla,  when  used  in  the  proper  amount,  might  give  immun- 
ity from  rabies. 

The  specific  cause  of  the  disease  seems  to  select  the  central  nervous  sys- 
tem as  its  most  favorable  habitat.  It  is  usually  present  in  the  saliva  and 
salivary  glands  of  dogs,  as  demonstrated  by  inoculation  of  other  animals 
with  this  material  being  followed  by  rabies,  but  whether  the  saliva  of  men 
who  have  the  disease  is  infectious  is  an  open  question.  Lagorio  writes 
me  that  he  has  made  a  number  of  experiments  with  the  saliva  of  three 
rabid  men,  and  in  no  instance  did  rabies  develop  in  the  inoculated  rabbits. 

In  Bardach's  experiments  the  juice  from  the  salivary  glandsof  twenty- 
two  persons  who  died  of  rabies  caused  the  disease  when  injected  into 
rabbits.     Bordoni   and  Uffredduzzi  made  similar  experiments  in  two 


*  Published  at  the  School  of  Medicine,  in  Paris,  1884. 
+  "  Les  Bacteries  "  (second  edition). 
i  Woodhbad:  "  Bacteria  and  their  Products,"  page  817. 

sTizzoni  and  Centanni— " Chemical  Vaccine  Against  Rabies:"  The  British  Medical  Journal,  Vol- 
ume 1, 1893. 


RABIES— HYDROPHOBIA.  23 

cases  with  negative  results.  The  glands,  in  Bardach's  experiments,  were 
not  removed  until  twelve  or  twenty-four  hours  after  death,  while  those  used 
by  Uffredduzzi  were  removed  in  three  to  six  hours  after  death;  post- 
mortem changes  may  have  occurred  in  the  former. 

The  statistics  of  the  Pasteur  Institute  in  Moscow,*  for  1892,  give  two 
instances  where  the  disease  was  communicated  from  man  to  man.  Doctor 
Calmette  reports  one  instance  of  the  disease  being  contracted  from  the 
bite  of  a  man,  as  having  occurred  in  the  Cochin  China  Institute.* 

PATHOLOGICAL   ANATOMY. 

There  is  " an  acute  hyperemia  of  the  larynx,  trachea,  and  bronchi" 
(Osler),  and  Gowers  says  there  is  "perivascular  exudation  of  leucocytes, 
and  minute  hemorrhages,  in  the  oblongata."  This  is  found  more  marked 
in  the  animals  which  survive  for  some  time,  and  is  known  as  miliary 
abscess.f  In  man  where  the  disease  is  so  rapidly  fatal  this  condition  is  not 
so  well  marked,  but  in  men  who  died  of  paralytic  rabjes  these  changes 
resemble  those  found  in  the  medulla  of  the  rabbit  and  may  be  widely 
diffused. 

Welch,  in  describing  the  lesions  he  had  observed  in  the  post-mortem 
examination  of  three  cases  of  rabies,  says  :  "  These  lesions  were  microscopi- 
cal, and  their  extent  and  distribution  could  be  determined  only  by  the 
examination  of  a  large  number  of  sections  of  different  parts.  The  lesions 
were  especially  well  marked  in  and  near  the  nuclei  of  origin  of  the  spinal 
accessory,  pneumo-gastric,  and  glosso-pharyngeal  nerves,  and  in  the  motor 
nucleus  of  the  trigeminus." 

That  the  pathological  anatomy  does  not  show  the  extent  and  presence  of 
the  specific  cause  is  obvious,  as  tissues  or  fluids  from  various  parts  of  the 
body  of  infected  animals  when  inoculated  into  healthy  animals  will  pro- 
duce the  disease,  although  nothing  can  be  demonstrated  in  the  tissues  or 
fluids  to  account  for  the  disease. 

SYMPTOMS   IN   ANIMALS. 

There  are  two  distinct  varieties  of  the  disease — the  maniacal  and  the 
paralytic.  The  disease  has  three  well-marked  stages — prodromal,  irrita- 
tive, and  paralytic. 

The  prodromal  stage  in  rabies  is  characterized  by  an  alteration  in  the 
manner  and  usul  actions  and  habits  of  animals.  If  the  disease  occurs  in  a 
domestic  animal  which  is  naturally  friendly,  it  may  suddenly  change, 
become  cross  and  surly,  and  almost  as  suddenly  again  become  natural  and 
affectionate.  The  animal  is  restless  and  not  contented  to  remain  in  one 
place.  Many  animals  are  dull,  lazy  and  seek  secluded  places.  There  is 
irritation  at  the  seat  of  the  wound  demonstrated  by  a  tendency  to  scratch, 
rub  or  ruffle  the  cicatrix.  Frequently  the  appetite  is  lost  and.  in  others 
there  is  a  depraved  ravenous  appetite,  evinced  in  dogs  and  pigs  by 
eating  all  sorts  of  strange  things,  such  as  pieces  of  wood,  and  iron. 
Carnivorous  animals  "  gulp  "  as  if  trying  to  free  themselves  from  some- 
thing, such  as  a  bone  in  their  throat,  and  vomiting  frequently  occurs.  The 
visible  mucous  membranes  are  red  and  saliva  (except  in  horses)  ^drivels 

*  Statistics  from  various  Pasteub  Institutes  will  be  found  on  subsequent  pages  of  this  paper, 
f  Babstow  and  Hobsley:    "  Transactions  of  the  Clinical  Society  of  London,  November,  1888." 


24  CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 

from  the  mouth.  These  symptoms  generally  last  from  twelve  to  forty- 
eight  hours,  and  then  pass  either  to  the  irritative  or  paralytic  stage. 

During  the  irritative  stage  there  is  great  propensity  to  injure  other 
animals,  uneasiness,  paroxysms  of  fury,  with  intervals  of  quietude,  and 
exhaustion.  During  the  paroxysms  dogs  may  tear  their  bedding,  or  what- 
ever comes  in  their  way,  and  snap  at  imaginary  objects.  The  tongue  is 
swollen  and  frequently  dipped  in  water  to  cool  it,  but  the  poor  animal  may 
not  be  able  to  swallow  and  saliva  hangs  in  strings  from  its  mouth.  How- 
ever, in  some  animals  this  symptom  is  not  so  bad,  and  the  animal  wants 
and  takes  a  great  amount  of  water.  The  gait  or  carriage  of  a  dog  is 
unsteady  and  he  soon  begins  to  totter.  The  dog  generally  goes  with  an 
unsteady  gait,  tail  between  his  legs,  bright  and  staring  eyes  that  soon 
become  dull,  head  rolling  from  side  to  side,  stomach  tucked  up,  mouth 
open  and  tongue  protruding.  It  is  said  by  those  who  have  seen  them  that 
it  is  quite  easy  to  distinguish  a  mad  dog  by  the  actions  above  described. 
In  Fleming's  work  on  "  Hydrophobia  and  Rabies  "  can  be  seen  a  picture 
of  a  rabid  dog,  and  it  is  probable  that  a  person  would  never  forget  it 
should  he  once  see  one.  A  peculiar  characteristic  of  a  mad  dog  is  that  he 
is  devoid  of  sense  of  pain  and  will  hold  a  red-hot  iron  in  his  mouth  with- 
out uttering  a  cry. 

Cats  are  very  savage  and  are  very  dangerous  on  account  of  their  great 
ferocity.  Horses  become  violent,  stamp  their  feet,  kick,  bite,  et  cetera, 
and  try  to  get  loose.  Cattle  rarely  use  their  teeth  but  paw  and  bellow,  and 
use  their  horns  and  frequently  break  them.  Pigs  slaver  at  the  mouth,  bite 
at  their  fellows  and  become  very  wild.  The  voice  of  all  animals  is  altered 
and  strange.  In  dogs  the  voice  is  one  of  the  best  diagnostic  symptoms.  It 
has  a  peculiar  high-toned,  croupy,  ringing  sound,  as  if  the  bark  and  the 
howl  were  blended  together.  At  first  the  paroxysms  are  prolonged  and 
violent,  and  finally  become  weak  and  short,  and  it  may  then  be  said  that 
the  paralytic  stage  has  set  in. 

In  the  paralytic  stage  there  is  paralysis  of  the  lower  jaw,  which  renders 
the  animal  unable  to  bite.  The  dog  generally  stays  at  home.  If  he  does 
go  away  he  quickly  returns,  and  seeks  some  secluded  spot,  in  which  he  may 
die.  The  tongue  is  swollen,  livid  and  hangs  out  of  the  mouth;  the  saliva 
is  tenacious  and  abundant,  paralysis  of  the  posterior  extremities  sets  in 
and  death  soon  follows. 

Babies  generally  makes  quick  work  of  the  animal,  and  may  take  a  rapid 
course  and  kill  within  forty-eight  hours.  It  rarely  lasts  more  than  ten 
days,  although  there  have  been  cases  of  canine  rabies  lasting  twenty  days. 
The  duration  depends  largely  upon  the  constitutional  vigor  of  the  animal. 

Hydrophobia  is  an  affection  of  the  nervous  system,  and  the  stimulus 
which  excites  the  paroxysm  is  conducted  often  from  the  ganglia  of  special 
sense,  or  even  from  the  brain,  so  that  the  sight  or  sound  of  fluids,  or  even 
the  idea  of  them,  occasions  equally  with  their  contact,  or  with  that  of  a 
current  of  air,  most  distressing  convulsions  (Caepenter). 

SYMPTOMS    IN    MAN. 

There  are  many  points  of  similarity  between  the  symptoms  of  hydropho- 
bia and  those  of  rabies.  There  is  some  sense  of  pain  in  or  near  the  seat  of 
the  wound,  extending  toward  the  body,  if  the  injury  had  occured  on  the 
limbs.  There  may  be  considerable  irritation  or  very  acute  pain  in  the 
cicatrix.     The  old  wound  may  swell  and  open,  or,  if  yet  unhealed,  assume 


RABIES— HYDROPHOBIA.  25 

an  unhealthy  appearance,  discharging  a  thin,  ichorous  fluid  instead  of  pus. 
Usually  there  is  a  general  nervous  disturbance;  the  patient  becomes 
dejected,  irritable  and  restless,  but  does  not  appear  to  have  any  idea  of 
what  may  be  the  cause  of  his  peculiar  feeling,  or,  if  he  does,  he  is  careful 
not  to  mention  it;  he  seeks  solitude  or  amusement  away  from  home;  his 
sleep  is  troubled;  he  often  starts  up  from  a  sound  sleep;  pains  are  often 
experienced  in  different  parts  of  the  body;  and  frequently  there  is  disorder 
with  the  digestive  apparatus.  After  these  premonitory  symptoms,  which 
vary  from  a  few  hours  to  a  few  days,  the  patient  becomes  sensible  of  a  stiff- 
ness or  tightness  about  the  throat  and  he  experiences  some  difficulty  in 
swallowing,  especially  fluids,  which  may  be  considered  as  the  commence- 
ment of  the  attack  in  man. 

The  difficulty  in  connection  with  swallowing  rapidly  increases  and  soon 
becomes  quite  impossible,  unless  it  is  attempted  with  determination,  which 
generally  throws  the  patient  into  convulsions;  there  is  a  sensation  of  tight- 
ness in  the  chest,  as  well  as  throat;  difficulty  in  breathing  and  necessity 
for  fresh  air.  The  most  marked  symptoms  are  the  spasms  or  convulsions 
which  are  brought  on  by  an  attempt  to  swallow,  or  may  even  be  brought 
on  by  the  mere  mention  of  liquids  or  knowledge  that  they  are  near,  or  by 
a  draft  from  the  window  or  fan.  The  sound  of  a  liquid  being  poured  from 
one  vessel  to  another,  or  the  application  of  any  cold  or  damp  substance 
to  the  body  may  bring  on  the  paroxysms.  The  patient's  face  wears  an 
expression  of  terror,  anxiety  or  despair.  During  one  of  these  convulsions 
the  patient  suffers  great  agony  and  it  is  quite  impossible  to  stand  by  and 
witness  the  suffering.  The  spasms  generally  last  but  a  few  seconds  and 
the  patient  then  becomes  tranquil,  but  the  least  disturbance  may  bring  on 
a  fresh  attack.  During  the  intervals  between  the  spasms,  the  patient 
is  calm,  rational  and  may  feel  thirsty,  but  on  trying  to  drink  is  uniformly 
thrown  into  another  convulsion.  The  patient  is  frequently  aware  of  the 
approach  of  these  attacks,  and,  fearful  of  doing  injury,  begs  to  be  restrained. 
The  patient  may  be  troubled  with  hallucinations  of  both  sight  and  hearing. 
Sometimes  the  patient  gives  away  to  wild  fury,  may  roar,  howl,  curse, 
strike,  may  try  to  bite  others  or  himself,  and  finally,  through  exhaustion, 
will  sink  into  a  gloomy  and  sleepy  state,  until  attacked  by  another  parox- 
ysm. The  tongue  is  swollen  and  red,  there  is  often  a  sense  of  burning  in 
the  throat,  with  thirst  which  cannot  be  satisfied.  There  is  generally  a 
secretion  of  a  viscid  tenacious  mucus  in  the  fauces  (called  the  "  hydrophobic 
slaver"),  of  which  the  patient  makes  every  effort  to  free  himself  and  spits 
it  out  to  drop  wherever  it  may.  This  mucus  is  generally  abundant  as  the 
disease  advances  and  the  lower  jaw  is  frequently  paralyzed,  and  the  mucus 
flows  from  the  corners  of  the  mouth.  Paralysis  may  become  quite  general 
before  death.  There  may  occur  times  during  the  disease  that  the  patient 
may  take  both  food  and  water  without  the  convulsions,  but  it  is  always 
with  much  difficulty.  The  temperature  gradually  rises  from  the  commence- 
ment of  the  disease,  and  frequently  as  high  as  105°  Fahrenheit  and  106° 
Fahrenheit.  Death  generally  follows  after  a  hard  convulsion.  The  desire 
to  bite  is  rare  in  man,  but  cases  are  recorded  where  the  bite  of  a  man 
has  caused  the  disease. 

The  duration  of  the  disease  is  somewhat  varied,  lasting  from  two  to  ten 
days.     In  324  cases  death  occurred  in  the  majority  of  cases  between  the 
second  and  fourth  days,  in  a  few  death  occurred  the  first  day,  and  in  a  few 
cases  life  was  prolonged  even  to  fifteen  days. 
4 


26  CHARLOTTE   SANITARY  CONVENTION,  NOVEMBER,  1894. 

PERIOD    OF    INCUBATION   IN    MAN. 

The  period  of  incubation  is  that  time  between  the  bite  and  the  appear- 
ance of  the  characteristic  symptoms  of  the  disease.  During  this  period 
the  patient  often  experiences  unnatural  conditions.  These  conditions 
have  been  described  on  preceding  pages  of  this  paper  under  the  head 
of  prodromal  or  premonitory  symptoms. 

Much  attention  has  been  given  to  the  subject  of  the  period  of 'incubation; 
and,  although  there  has  been  found  no  fixed  number  of  days  in  which  the 
disease  will  surely  appear,  if  at  all,  in  most  cases  the  disease  shows  itself 
between  forty  and  sixty  days.  The  period  has  frequently  been  much  less, 
and  even  as  short  as  one  day  in  some  cases,  and  in  other  cases  as  long  as 
two  and  one-half  or  three  years.  Rouche  has  observed  that  in  Algiers  the 
average  period  is  fifty-one  days,  the  ordinary  minimum  thirty  days  and  the 
maximum  ninety  days.  Doctor  Fleming  records  224  cases  in  which  the 
latency  was  less  than  a  month  in  40,  from  one  to  three  months  in  143, 
from  three  to  six  months  in  30,  and  from  six  to  twelve  months  in  11  cases. 
Trousseau  says  the  incubation  period  may  vary  from  a  few  days  to  a  year. 
Haguenot  cites  a  case  where  a  peasant  was  suffering  from  hydrophobia  on 
the  third  day  after  receiving  his  wound  from  a  mad  wolf.  Finco,  of  Padua, 
cites  a  case  where  a  young  woman  developed  the  disease  14  years  after 
being  bitten  by  a  mad  dog.  Instances  of  extremely  short  or  extremely 
long  periods  of  incubation  are  recorded  but  it  is  possible  that  there  are 
mistakes  made  as  regards  the  date  of  receiving  the  bite  which  causes  the 
disease. 

Doctor  Bauer  recorded  his  observations  on  510  cases  and  found  that 
the  average  period  was  72  days.  In  the  male  the  average  period  was  80 
days,  and  in  the  female  it  was  65  days.  He  thought  that  age  had  consider- 
able influence  and  that  the  period  was  shortened  20  days  in  patients  under 
fourteen  years  of  age.  He  found  that  in 
49  cases  where  a  wolf  caused  the  bite,  the  av.  incubation  period  was  39  days. 
293    "        "      "  dog      "        "      "      "     "  "  "         "    73    " 

0  u  a  a  £QX  a  u         te  a       a  a  <c  i(     gg       (f 

31     "        "       "  cat        "        "       "       "     "  "  "  "    80     " 

1  "        "       "  cow      "        "       "       "     "  "  "  "    30     " 

Doctor  Kraiouchkine,  director  of  the  Saint  Petersburg  Institute, 
informs  me  that  his  experience,  during  the  years  1886  to  1892,  leads  him 
to  announce  that  the  period  of  incubation  varies  from  16  to  494  days;  the 
average  period  being  about  60  days. 

Doctor  Augusto  F.  des  Santos,  director  of  the  Pasteur  Institute  at 
Rio  Janerio,  writes  me  that  his  experience  indicates  that  the  period  of 
incubation  is  from  30  to  90  days. 

Doctor  Padilla,  of  the  National  Department  of  Hygiene  of  the  Argen- 
tine Republic,  states  that  in  cases  he  has  observed  the  average  period  was 
40  days. 

Doctor  A.  N.  Blodgett,  of  Boston,  says  that  in  seventeen  per  cent,  of 
ail  cases  of  rabies  in  man  the  period  is  three  months  or  over. 

Pasteur  says  that  the  disease  shows  itself  in  a  majority  of  cases  in  40 
to  60  days  after  receiving  the  bite,  which  is  probably  the  period  which 
will  most  commonly  be  observed.     However,  the  location  of  the  bite  has 


KABIES— HYDEOPHOBIA.  27 

much  to  do  in  influencing  the  time  of  the  appearance  of  the  disease.  It 
has  been  found  that  where  the  wound  was  located  on  the  head  or  neck  the 
incubation  period  was  35  days,  on  the  upper  extremities  81  days,  and  on 
the  lower  extremities  74  days. 

In  India,  in  1893,  it  has  been  observed  that  in  the  cases  of  hydrophobia, 
the  period  of  incubation  was  uniformly  about  90  days. 

INCUBATORY  PERIOD  IN  ANIMALS. 

In  regard  to  the  period  of  incubation  in  animals,  Doctor  Fleming,  in 
his  exhaustive  work,  "  Hydrophobia  and  Rabies,"  gives  detailed  and  elab- 
orate results  of  different  observers.  Lafoss  states  that  the  shortest 
authenticated  period  in  the  dog  that  occurred  in  his  experience  was  7  days 
and  the  longest  was  155.  Blaine  asserts  that  the  majority  of  cases  occur- 
red between  the  third  and  seventh  week.  Haubner's  experience  in  200 
cases  showed  that  in  83  per  cent,  the  period  was  within  two  months;  the 
average  being  three  months. 

With  the  cat  the  incubatory  period  is  said  to  be  from  two  to  four 
weeks. 

According  to  Roll  the  period  in  the  horse  varies  from  15  days  to  two 
months. 

Haubner  found  that  in  the  ox  that  it  varied  from  nine  days  to  several 
months.  In  234  cases  10  per  cent,  developed  the  disease  in  about  three 
months. 

In  sheep  two  weeks  seem  to  be  the  minimum  and  four  weeks  the 
maximum. 

Pigs  occasionally  develop  rabies  in  nine  days,  but  it  does  not  usually 
appear  until  the  fourth  week  after  infection. 

THE   PASTEUR   TREATMENT. 

Prior  to  October  26,  1885,  when  M.  Pasteur  announced  to  the  Academie 
des  Sciences  de  Paris  that  he  had  discovered  a  treatment  which  would 
prevent  the  development  of  hydrophobia  in  man,  it  was  conceded  generally 
that  hydrophobia  was  always  fatal.  Imagine  the  great  surprise  and  wonder 
which  followed  the  announcement  of  this  great  discovery,  second  only 
perhaps  in  importance  in  preventive  medicine  to  that  of  Jenner.*  It  is 
not,  however,  to  be  wondered  at  that  the  suspicious  and  incredulous  were 
ready  to  question  the  efficacy  of  the  treatment,  but  it  is  now  gratifying  to 
say  that  the  method  has  been  thoroughly  tested  by  scientific  men  all  over 
the  world  and  there  is  probably  now  no  doubt  in  any  informed  mind  but 
that  Louis  Pasteur  is  a  great  benefactor  and  has  done  much  to  relieve 
suffering  humanity. 

The  careful  and  unbiased  experiments  of  Doctor  Ernst,  of  Boston, 
Doctors  Welch  and  Kierle,  of  Baltimore,  Doctor  Shakespeare,  of 
Philadelphia,  and  others  in  this  country  have  fully  confirmed  the  state- 
ments and  methods  of  M.  Pasteur  and  his  illustrious  co-workers  in 
Europe. 

Before  Pasteur  announced  his  discovery,  he  and  other  experimenters 
spent  much  valuable  time  in  trying  to  bring  about  the  same  results,  but 

*  Up  to  this  time  the  antitoxin  treatment  of  diphtheria  has  not  been  universally  adopted. 


28  CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 

Pasteue  was  first  to  make  his  method  public,  and  has  since  treated  many 
persons  proved  to  be  or  supposed  to  have  been  innoculated  with  hydro- 
phobic virus.  At  first  his  inoculations  were  made  at  his  laboratory  in  the 
Rue  d'Ulm;  but  since  the  method  came  to  be  recognized  by  nearly  all  the 
world,  a  grant  of  several  million  francs,  from  the  Imperial  Treasury,  for 
a  new  laboratory  and  its  equipment,  and  a  donation  of  a  whole  block  of 
ground  in  the  heart  of  that  great  city,  Pasteue  has  built  and  is  now 
occupying  a  magnificent  institute,  standing  back  from  the  street,  occupy- 
ing the  block  donated  by  the  city  and  surrounded  by  a  beautiful  grass-plot. 
In  front  on  the  lawn  will  be  found  a  bronze  statue  representing  a  boy  strug- 
gling with  a  mad.  dog  which  indicates  at  least  one  branch  of  work  carried 
on  inside  the  building.  This  well-equipped  laboratory  is  occupied  by 
Pasteue  and  his  corps  of  untiring  searchers  for  knowledge,  ever  trying  to 
discover  some  new  vaccine  or  other  preventive  of  disease.  The  laboratory 
is  for  practical  work  in  different  branches  of  micro-biology,  and  associated 
with  Pasteue  are  some  fifteen  directors  and  assistants.  Among  these 
valuable  assistants  may  be  mentioned  such  notables  as  Roux,  Yebsin, 
Metsohnikoef,  Stbaus,  Duclaux,  Chantemesse,  Gbancheb,  and  others, 
each  working  in  his  special  line. 

In  way  of  digression,  and  as  an  instance  of  some  of  the  recent  valuable 
work  coming  from  this  institute,  I  might  mention  that  it  was  Doctob 
Roux,  of  the  Paris  Pasteue  Institute,  who,  at  the  meeting  of  the  Interna- 
tional Congress  of  Hygiene  and  Demography,  at  Budapest!).,  September  1 
to  9,  1894,  gave  to  the  congress  and  to  the  public  the  results  of  his  experi- 
ments in  connection  with  the  treatment  of  diphtheria  by  the  immunizing 
blood  serum  of  the  horse.  While  Doctob  Behbing  practically  left  his  method 
a  secret,  Doctob  Roux  revealed  every  detail  of  his  method,  and  offered  to 
supply  the  serum,  and  made  known  his  intention  to  give  his  time  to  the 
prevention  of  diphtheria. 

One  can  well  see  how  a  man  of  Pasteue's  temperament  should  have 
such  a  deep  interest  in  a  disease  attended  by  such  fearful  suffering 
for  both  patient  and  friends.  It  was  in  1880  that  he  began  his  study 
of  the  etiology  of  hydrophobia.  He  obtained  from  a  child  suffering 
with  the  disease  a  small  quantity  of  the  saliva  and  injected  it  under 
the  skin  of  a  rabbit;  the  animal  died  in  two  days.  Taking  some  of 
the  saliva  of  this  rabbit,  he  treated  another  rabbit,  and  in  that  the 
disease  was  produced  in  a  most  virulent  form.  Continuing  his  experi- 
ments he  found  that  by  trephining  a  healthy  rabbit  and  taking  a  few  drops 
of  the  cerebro-spinal  fluid  and  injecting  it  under  the  dura  mater  of  the 
healthy  rabbit  the  disease  rapidly  developed  and  with  more  certainty  than 
by  the  use  of  the  saliva,  but  was  not  of  so  virulent  a  type.  Fragments  of 
the  brain  and  spinal  cord  also  produced  the  disease,  and  he  then  abandoned 
the  use  of  the  saliva.  Knowing  by  previous  experiments  with  anthrax 
virus  that  the  virulence  of  the  virus  might  be  increased  or  decreased  by 
inoculation  into  animals  of  another  species  he  followed  out  the  same  lines 
of  work  with  hydrophobic  virus  and  obtained  similar  results.  Inoculation 
from  dog  to  dog  killed  at  the  same  period  of  incubation  and  in  practically 
the  same  time;  but  inoculation  from  dogs  to  monkeys  gave  a  weaker  or 
more  attenuated  virus,  the  virus  becoming  more  attenuated  by  successive 
inoculations  from  monkey  to  monkey,  until  there  came  a  time  when  the 
virus  was  so  weak  that  it  would  fail  to  cause  the  disease.  If  this  weakened 
virus  were  then  inoculated  into  a  rabbit  or  dog  it  remained  inactive  for  a 


RABIES— HYDROPHOBIA.  29 

time,  but  by  successive  inoculations  the  virus  regained  its  original  viru- 
lency.  However,  if  these  series  of  inoculations  be  made  into  a  rabbit 
with  the  primary  virus  from  a  dog  the  virus  gradually  grows  stronger 
instead  of  weaker  until  it  is  even  more  malignant  than  the  fresh  virus 
from  a  dog  suffering  from  street  rabies.  For  instance,  if  a  rabbit  be  inocu- 
lated with  the  virus  of  a  rabid  dog  the  rabbit  will  show  symptoms  in  about 
fifteen  days,  never  shorter  than  nine  days;  if,  however,  the  virus  of  this  first 
rabbit  be  used  on  a  second  rabbit  the  period  of  incubation  is  shorter ;  if 
a  third  rabbit  be  likewise  treated  with  the  virus  of  the  second,  the  period 
is  still  shorter,  and  so  on  until  it  is  reduced  to  six  or  seven  days,  at  which 
time  the  period  of  incubation  becomes  stationary  or  what  Pasteur  calls  a 
"  fixed  "  virus ;  that  is,  the  period  of  incubation  is  always  six  or  seven  days, 
and  the  animal  certainly  dies  on  the  tenth  day  after  inoculation.  This 
discovery  was  of  great  importance  to  Pasteur,  as  he  was  able  to  deter- 
mine exactly  when  the  animal  would  die,  and  was  able  to  obtain  a  fixed  and 
regular  supply  of  virus  for  his  every-day  inoculations. 

Pasteur  had  observed  that  the  spinal  cord  of  rabbits  dead  from  rabies 
gradually  lost  its  virulence  in  direct  ratio  to  the  time  intervening  after  the 
death  of  the  rabbit.  This  and  other  facts  lead  him  to  believe  he  could 
obtain  an  inoculation  material  of  different  degrees  of  virulence,  which 
could  be  relied  upon  for  the  treatment  of  human  beings.  Accordingly  he 
injected  a  rabbit  with  the  "  fixed  "  virus,  and  when  the  rabbit  died  the 
spinal  cord  was  hung  in  a  dry,  sterilized  bottle  and  kept  at  a  temperature 
of  17°  centigrade  to  18°  centigrade  (63°  Fahrenheit  to  65°  Fahrenheit) . 

The  cord  of  "  one  day  "  drying  was  found  to  be  slightly  weaker  and 
when  injected  into  another  rabbit  still  produced  the  disease,  but  the  death 
of  the  rabbit  was  prolonged  just  one  day  more  than  it  would  have  been 
had  the  rabbit  been  inoculated  with  the  fresh  virus.  Inoculation  with  the 
spinal  cord  of  two  days'  drying  prolonged  life  in  the  rabbit  one  day  longer. 
He  found  that  the  virulence  decreased  in  direct  proportion  to  the  tempera- 
ture and  the  length  of  time  it  had  been  dried,  the  weaker  the  injecting 
emulsion,  the  longer  the  period  of  incubation  and  the  longer  death  was 
delayed;  the  cord  that  had  been  dried  fifteen  days  nearly  uniformly  failed 
to  produce  the  disease;  and  the  cord  that  had  been  dried  only  one  day  was 
nearly  as  strong  as  the  first  virus. 

Doctor  Uffredbuzze*  found  that  if  the  cord  was  dried — 
2  days  it  produced  death  in  11  to  17  davs,  but  postponing  it 
"  "      "    14  to  16     "      " 

"       "    12  to  15     "       " 

"      "    17  to  20    "      " 

"      "    12  to  22    "      " 

"      "   23  to  29    "      " 
"  "      "   24  to  27     "      " 

"      "   27  to  40    "      " 

"      "    32  to  36    '•'      " 

"      "   30  to  35    "      " 

*  From  a  paper  by  Dootob  Ruffek,  read  before  the  Section  on  Medicine  of  the  British  Medical  Asso- 
ciation, at  Leeds,  August,  1889. 


3 

a         a 

4 

it        u 

5 

(t         (c 

6 

tt         a 

7 

a        a 

8 

it         it 

9 

a        i. 

10 

it          tt 

11 

u         a 

t 

1  to    2  days 

(> 

4  to    6 

a 

tt 

2  to    5 

a 

a 

7  to  10 

it 

ii 

2  to  12 

a 

ii 

13  to  19 

a 

ii 

14  to  17 

a 

tt 

17  to  30 

a 

a 

22  to  26 

a 

a 

20  to  25 

tt 

30  CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 

It  had  been  known  for  some  time  that  every  microorganism  during  its 
growth  excreted  substances,  just  as  higher  animals  excrete  certain  sub- 
stances every  day,  and  that  some  microorganisms,  such  as  those  of  anthrax, 
malignant  edema,  et  cetera,  excrete  a  chemical  substance  (ptomain,  toxin, 
et  cetera),  which  when  injected  into  an  animal  will  render  that  animal 
immune  against  an  invasion  of  the  specific  organisms  of  that  disease. 
Pasteur  was  the  first  to  point  out  that  vaccination  could  probably  be 
accomplished  by  use  of  these  chemical  substances,  and  thus  opened  a  new 
field  for  original  research . 

By  inoculating  under  the  skin  of  a  dog  an  emulsion  of  the  spinal  cord 
of  a  rabbit  recently  dead  of  rabies  the  microorganism  of  rabies  and  the 
chemical  excrement  of  the  microorganism  are  at  the  same  time  introduced. 
This  chemical  substance  at  once  proceeds  to  destroy  the  microorganism 
and  by  the  time  the  microorganism  would  naturally  produce  the  disease 
the  chemical  substance  has  performed  its  work  and  has  produced  the 
immunity.  If  a  small  quantity  of  the  rabic  virus  (emulsion)  be  introduced 
into  an  animal  only  a  small  quantity  of  organism  and  a  small  quantity  of 
the  vaccinating  substance  are  introduced  and  the  animal  dies  from  rabies; 
but  if  10  to  20  or  30  cubic  centimetres  of  the  emulsion  be  injected  a  large 
quantity  of  the  organisms  and  at  the  same  time  a  large  quantity  of  the 
chemical  vaccinating  substance  is  introduced  which  overpowers  the  micro- 
organism and  prevents  the  disease  from  developing. 

Pasteur  took  fifty  dogs  and  inoculated  them  in  ten  successive  days, 
commencing  with  the  weakest  virus  and  each  day  using  one  of  more  strength 
until  at  the  end  of  the  treatment  he  could  inoculate  them  with  the  strong- 
est virus,  even  with  the  virus  of  a  dog  suffering  with  street  rabies  (rage  de 
la  rue).  In  this  way  he  produced  an  immunity  which  lasted  apparently 
for  at  least  two  years,  and  probably  for  a  considerably  longer  time. 

Thus  Pasteur  had  been  able  to  protect  animals  from  rabies,  but  he 
found  his  method  for  animals  was  not  entirely  applicable  to  man.  How- 
ever, Pasteur  was  equal  to  the  difficulty.  It  will  be  remembered  the 
longer  the  cord  was  dried  the  fewer  the  microorganisms,  but  there  was 
left  a  goodly  quantity  of  their  chemical  excrement  or  vaccinating  sub- 
stance for  his  treatment  of  man.  He  made  two  injections  each  day,  com- 
mencing with  the  cord  of  fourteen  and  thirteen  days,  on  the  second  day 
with  the  emulsion  of  the  cord  of  twelve  and  eleven  days,  the  third  day 
with  the  cord  of  ten  and  nine  days,  the  fourth  day  the  cord  of  eight  and 
seven  days  drying,  the  fifth  day  only  the  cord  of  six  days,  and  so  on.  This 
process  finally  came  to  be  known  as  the  "  simple  method." 

The  simple  method  has  been  found  sufficient  in  most  cases;  but,  where 
the  patient  has  been  bitten  badly  on  the  face  or  head,  a  more  intensive 
method  has  been  found  necessary,  because  in  such  cases  the  period  of 
incubation  is  generally  shorter  and  there  is  need  for  more  active  and  vigor- 
ous measures,  and  thus  the  "  intensive  method  "  came  to  be  used.  Each 
injection  consists  of  one-half  cubic  centimeter  of  the  crushed  cord  in  two 
cubic  centimeters  of  sterilized  beef  tea.     The  patient  is  inoculated  on  the 


RABIES— HYDROPHOBIA. 


31 


1st  day  with  the  cord  of  14,  13,  12,  11  days  drying. 


2d 

3d 

4th 

5th 

6th 

7th 

8th 

9th 

10th 

11th 

12th 

13th 

14th 

15th 


10,  9,  8, 
6 
5 
5 
4 
3 
4 
3 
5 
5 
4 
4 
3 
3 


(Two  inoculations) 


On  the  sixteenth  and  seventeenth  days  there  is  a  rest,  and  on  the  eigh- 
teenth, nineteenth  and  twentieth  days  there  is  one  inoculation  each  day 
with  the  cord  of  five,  four  and  three  days  drying,  respectively,  which  ends 
the  treatment. 

The  following  diagram  will  show  at  a  glance  the  "  simple  "  and  "  inten- 
sive "  methods  of  treatment  employed  at  the  Pasteur  Institute: 


PASTEUR'S 

ANTIRABIC 

INOCULATIONS 

-  "simple"  and"intensive"methods.  . 

SPIJML 

cep.a, 

OAYS 
DRIED. 

DAYS    OF   INOCULATIONS  . 

/ 

2 

3 

f 

5 

6 

7 

g 

7 

10 

// 

12 

13 

/¥ 

15 

lb 

17 

it 

17 

20 

14 

•  • 

7  3 

3 

^ 

11 

• 

• 
1 

// 

• 

1 

10 

• 
< 

> 

9 

• 
• 

1 

? 

■ 

• 

1 

« 

7 

• 
— \- 

1 
\ 

6 

< 

*\ 

> 

**- 

> 

«fr 

*•.. 

••.  ; 

-v 

5ij 

•— 
J?" 

— • 

>, 

4- 

% 

V 

^ 
,•>< 

/ 

'» 

,  «  — 

-• 

* 

* 

3 

'*•*' 

V 

V 

\ 

,'** 

1 

1 

.  ; 

Jfote  —  ^acA  Dot  represents  one  injection.  <Sach  injection  consists  cf    about  one-half  of  a 
cubic  centimeter  of  spinal  coed  emitted  in  tuio  cubic    centimeters  of  sterilized  beef  tea, . 


32  CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 

By  means  of  the  hypodermic  needle  subcutaneous  injections  are  made 
into  either  side  of  the  abdomen  just  above  the  crest  of  the  ilium.  Every 
precaution  is  taken  that  other  complications — as  abscess,  syphilis,  erysipe- 
las, et  cetera — are  not  spread  from  one  patient  to  another.  The  injecting 
fluid  is  perfectly  free  from  all  pus-forming  microorganisms,  the  needle  is 
sterilized  after  each  injection  and  in  other  ways  asepsis  is  provided. 
Doctor  Buffer  says  he  has  seen  many  thousands  of  inoculations  made 
and  has  yet  to  observe  one  instance  of  abscess  resuting  therefrom. 

The  personal  inconveniences  experienced  during  the  antihydrophobic 
treatment  are  very  slight.  Following  the  example  of  a  number  of  other 
directors  and  assistants  connected  with  other  Pasteur  institutes  and  for 
protection  against  a  possible  accidental  inoculation  while  performing  their 
every-day  duties,  Doctor  Paul  Gibier,  director  of  the  New  York  Institute, 
innoculated  himself  and  two  of  his  assistants.  In  a  paper  read  before  the 
New  York  County  Medical  Association,  May,  1890,  he  gives  in  detail 
these  interesting  experiments.  A  brief  mention  of  their  experience  may 
be  of  interest  to  the  readers  of  this  paper. 

The  treatment  was  according  to  the  simple  method.  The  injections  of 
the  first  four  days  were  followed  by  a  slight  irritation  and  redness  at  the 
site  of  the  injection,  and  sleep  was  somewhat  disturbed  at  night  by  a  sensi- 
tiveness at  the  spot  of  inoculation.  There  was  also  a  slight  rise  of 
temperature.  These  symptoms  remained  during  the  first  ten  days  of  the 
treatment;  then  the  tissues  seemed  to  have  accustomed  themselves  to  the 
injections  and  the  above-mentioned  symptoms  decreased  in  severity  and 
three  days  after  the  last  inoculation  there  remained  hardly  a  trace  of  the 
injections.  Gibier  said  there  was  unusual  activity  of  his  salivary  glands, 
and  several  times  each  day  he  was  obliged  to  eject ;  that  during  the  last 
week  of  the  treatment  and  the  week  following  he  had  a  certain  heavi- 
ness of  his  head  and  felt  unable  to  work.  The  same  symptoms,  with  the 
following  additional  ones,  were  experienced  by  his  assistants:  after  inocu- 
lation with  marrow  of  the  sixth  day,  one  assistant  complained  of  sudden 
pain  in  his  right  side  lasting  about  one  hour,  and  at  times  during  the  last 
week  of  the  treatment  suffered  neuralgic  pains  in  different  parts  of  his 
body,  and  dizziness  which  rendered  walking  difficult;  during  most  of  the 
treatment  the  other  assistant  suffered  more  or  less  severe  local  and  general 
pains.  These  symptoms  continued  for  about  fifteen  days  after  the  treat- 
ment, accompanied  by  unusual  sexual  excitement,  sadness,  undefined 
preoccupation  and  neuralgic  pains.  About  fifteen  days  after  the  last 
inoculation  each  assistant  experienced  pain  in  the  spots  where  the  injec- 
tions were  made. 

Doctor  Kraiouchkine,  of  the  Saint  Petersburg  Institute,  says  he  has 
noticed  during  the  treatment  almost  no  general  reaction  on  the  organism, 
but,  with  the  exception  of  very  rare  cases,  he  has  observed  lassitude,  or 
fatigue,  accompanied  with  headache  and  sleepiness  but  without  elevation  of 
temperature.  Very  often  there  is  a  local  reaction  of  the  pricked  spot, 
redness,  swelling,  edema  and  hardening,  but  a  little  cold  cream  and  rice 
powder  makes  it  disappear  rapidly.  This  local  reaction  produces  princi- 
pally on  the  individual  a  very  thick  cutaneous  tissue,  but  abscesses  have 
never  formed. 

Doctor  Ullmann  and  his  four  assistants  also  took  the  treatment  to 
insure  against  accidental  inoculations. 


RABIES— HYDROPHOBIA. 


33 


PASTEUEISM,   AND   ITS   EESULTS. 

Since  the  establishment  of  the  Paris  Pasteur  Institute  for  the  preven- 
tive treatment  of  hydrophobia,  many  institutes  and  laboratories  have  made 
preparations  to  give  the  treatment,  until  to-day  such  institutions  are  so 
numerous,  and  conveniently  located  as  to  be  accessible  to  all.  To  my 
knowledge  they  are  now  located  in  Paris,  Saint  Petersburg,  Odessa,  Vienna, 
Moscow,  Constantinople,  Milan,  Naples,  Lisbon,  Barcelona,  Bucharest, 
Cochin  China  (at  Sagon),  Mexico,  Havana,  Tunis,  Padua,  Kharkof,  Bud- 
apesth,  Stamboul  (Turkey),  Buenos  Ayres,  Rio  de  Janerio,  Turin,  Cal- 
cutta and,  last  but  not  least,  in  New  York  and  Chicago. 

Early  in  the  year  effort  was  made  toward  the  establishment  of  a  Pasteur 
Institute  at  Simla,  India,  not  only  for  antihydrophobia  inoculations  but 
for  the  systematic  and  specialized  investigations  into  the  causation  and 
prevention  of  various  diseases.  The  movement  has  been  received  with 
much  favor .  Donation s,  government  grants  and  subscriptions  from  individ- 
uals and  municipalities  have  been  made,  and  the  government  has  promised 
the  services  of  a  capable  medical  official.  It  is  probable  that  the  institute 
is  now  in  working  order. 

In  April  of  this  year  the  British  Institute  for  Preventive  Medicine  made 
application  to  erect  a  Pasteur  Institute  at  Chelsea,  England.  There  was 
some  objection  by  the  residents  of  Chelsea,  claiming  that  it  would  not 
only  depreciate  the  adjoining  property,  but  would  be  a  possible  source  of 
infection.  The  institute  has  been  commenced  and  although  the  building 
proper  is  not  yet  completed  work  is  being  pursued. 

It  is  announced  that  antihydrophobia  stations  are  soon  to  be  established 
in  various  cities  of  Turkey,  among  which  are  especially  mentioned  Yemen, 
Bagdad,  Damascus,  Erzeroum,  and  Monastir. 

In  Paris — M.  Pasteur,  Director. 

Since  Joseph  Meister  was  treated  antihydrophobically  many  thousands 
of  people  have  undergone  the  inoculations  at  the  Paris  Pasteur  Institute. 
The  following  table  will  give  you  the  results  during  the  years  1886 — 1893 : 


Years. 

Persons 
treated. 

Deaths, 

Death-rate 
per  cent. 

1886 

2,571 
1,770 
1,622 
1,830 
1,540 
1,559 
1,790 
1,648 

25 

14 
9 
7 
5 
4 
4 
4 

0.94 
0.79 
0.55 
0.38 
0.32 
0.25 
0.22 
0.24 

1887. ..._ 

1888 __ 

1889. 

1890 •_. 

1891 

1892 

1893 ._ .__ 

Total ._ 

14,330 

72 

0.50 

34 


CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 


Pasteur  has  established  a  custom  of  dividing  the  cases  into  three  classes, 
namely: 

(A)  Those  bitten  by  animals  proved  to  be  rabid,  by  laboratory  experi- 
ments, or  by  the  death  of  other  persons  or  animals  bitten  by  the  same 
animal. 

(B)  Those  bitten  by  animals  recognized  by  clinical  or  veterinary 
examination  to  be  rabid;  and 

(C)  Those  bitten  by  animals  supposed  to  have  been  rabid. 

These  rules  have  been  generally  followed  out  in  the  statistical  results  of 
Pasteur  Institutes. 


Years. 

A 

B 

C 

,0  CO 

Dg 
S5-3 

13 

s 

CO  u 
0  o 

Ms 
ag 

55  ♦* 

T3 
CD 

s 

.2  a 

-i  cb 

a  o 

o  co 

ag 

a  t- 

T3 
CD 

s 

.2  CI 
>-<  CO 

SI 

1886... 
1887. _. 
1888... 
1889.. _ 
1890... 
1891... 
1892... 
1893— 

223 
357 
403 
348 
385 
313 
139 
HI 

5 

2 
7 
4 
0 
0 
1 
0 

2.15 

0.56 

1.74 

1.15 

0 

0 

0.72 

0 

1,931 
1,161 

974 
1,188 

960 

967 
1,052 

937 

24 
15 
4 
9 
3 
7 
3 
7 

1.24 
1.29 
0.41 
0.25 
0.95 
0.72 
0.29 
0.75 

518 
260 
248 
298 
223 
313 
609 
497 

7 
4 
1 
3 
0 
2 
2 
2 

1.35 
1.54 
0.40 
1.00 
0 
0.64 
0.33 
0.40 

2,279 

19 

9,170 

72 

2,966 

21 

Of  the  1,648  treated  during  1893, 178  came  from  places  outside  of  France; 
43  from  Spain;  35  from  Greece;  23  from  England;  22  from  Belgium;  18 
from  Egypt;  14  from  British  India;  9  from  Switzerland;  9  from  Holland; 
6  from  Portugal;  Germany  and  Turkey,  2  each;  and  Austria,  United 
States,  Brazil,  Russia  and  Morocco,  one  each. 

Since  the  foundation  of  the  institute,  no  fewer  than  14,380  have  been 
treated  by  the  Pasteur  method  in  Paris.  Of  these  1,213  (16  fatal  cases) 
were  bitten  on  the  head,  8,032  (45  fatal  cases)  on  the  hands,  and  5,185 
(11  fatal  cases)  on  the  limbs. 

In  August,  1884,  in  the  absence  of  M.  Pasteur,  Doctor  Eoux  replying 
to  an  inquiry,  stated  that  nothing  had  yet  been  done  in  preventing  the 
development  of  hydrophobia  in  human  beings  infected  with  the  disease. 
Contrast  this  statement  of  Doctor  Roux  with  a  statement  that  he  would 
have  been  able  to  make  at  the  close  of  the  year  1893,  when  14,330  persons 
have  been  treated  with  a  mortality  of*  only  0.50  per  cent. 

The  statistics  of  the  Paris  Institute  show  that  the  majority  of  cases  of 
hydrophobia  occur  between  the  months  of  February  and  May. 

At  Turin,  Italy. 

During  the  period  from  September  30,  1886,  to  September  30,  1893, 
there  have  been  treated  a  total  of  1,738  persons,  with  8  deaths,  or  a  mor- 
tality of  .46  per  cent. 


BABIES— HYDROPHOBIA.  35 

At  New  York — Doctor  Paul  Gibier,  Director. 

Statistics  of  the  Preventive  Treatment  against  Hydrophobia  since  its 
opening — from  February  18,  1890,  to  January  1,  1895  (nearly  four  years): 


Bites  inflicted  on  the  ^  simple 
head  and  on  the  face  (  multiple 
,-»....      ( efficacious.- 

A* 

B* 

c* 

5 

ill 

18 

11 

9 

----- 

17) 
16$ 

33 

Cauterization  j  ^-efficacious . 
No  cauterization 

7 
11 

~~2~ 
49 
61 

9 

24 

1 

47 
65 

"§" 

30 

36 

5 

6 

9 

1 
40 
59 

"T 

15 

23 

14 

9 

Bites  inflicted  on  the  (  simple 
hands /multiple 

No  cauterization               

64) 
49  \ 

113 

58) 
42  ) 

100 

63) 
50$ 

113 

-fiY 

23) 

44 

Bites  inflicted  on  the    (  simple 

limbs    and    on    the   ■] 

body .(multiple 

~     ....      {efficacious    

23} 

15) 

38 

50  ~) 
19) 

69 

Cauterization  ]  "J°    „Jr™„-"~ 
(  non-efficacious  - 

No  cauterization 

28 

16 

11 

3 

Clothes  torn                  

Bites  inflicted  on  bare  parts 

Bites  inflicted  on  different  parts 
or  the  body 

1 

1 
12 

5 

5 

11 

10 

Cauterization  \  efflcacwus...... 

(  non-efficacious  - 
No  cauterization 

1 
4 
'  8 
1 
9 

1 
8 

7 
4 
9 

4 
6 
1 
4 

Bites  inflicted  on  bare  parts 

231 

188 

157 

•    576 

*  The  column  A  refers  to  persons  bitten  by  animals  in  which  hydrophobia  has  been  evidenced  by  exper- 
imentation or  by  the  death  of  some  other  persons  or  animals  bitten  by  them;  column  B  to  persons  who 
have  been  wounded  by  animals  having  been  recognized  rabid  by  the  clinical  or  veterinary  examination; 
and  column  C  to  cases  in  which  hydrophobia  could  only  be  suspected,  as  the  animals  had  disappeared  or 
were  killed  instantly  and  their  bodies  thrown  away, 


Of  the  576  persons  treated  during  the  period  from  February  18,  1890,  to 
January  1,  1895,  there  were  only  four  deaths,  or  a  mortality  of  0.67  per 
cent.  In  The  New  York  Therapeutic  Gazette,  for  September,  1894, 
Doctor  Gibier  exhibits  some  very  interesting  tables.  One  table  shows 
that  40  persons  who  were  bitten  by  dogs  which  bit  and  caused  the  death 
of  other  animals,  were  treated  successfully.  Another  table  shows  where 
24  persons  who  were  bitten  by  dogs  whose  bite  caused  the  death  by  hydro- 
phobia of  some  other  persons,  were  treated  successfully.  In  one  of  these 
cases  four  men,  in  another  three  men  and  a  child,  in  a  third  a  woman  and 
a  child  and  in  the  rest  of  these  cases  one  person,  all  subsequently  died  of 
hydrophobia. 

Of  the  85  persons  treated  in  1893,  26  were  bitten  by  animals  proved  to 
be  rabid,  11  by  animals  recognized  by  clinical  or  veterinary  examination 
to  be  rabid,  the  remaining  48  were  bitten  by  animals  suspected  of  rage. 


36 


CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 


At  Odessa,  Russia — Doctor  Buivid,  Director. 

During  the  year  1890  there  were  treated  at  Odessa  727  persons  (443 
males  and  284  females).  Among  this  number  257  were  children  of  10 
years  or  under. 

In  649  cases  the  animal  causing  the  bite  was  a  dog,  in  43  a  cat,  in  6  a 
horse,  in  4  a  wolf,  in  3  an  ox,  and  in  3  a  pig. 

In  201  cases  the  animal  causing  the  bite  was  proved  experimentally  to 
be  rabid,  in  10  by  death  of  other  animals  bitten  at  the  same  time,  in  261 
by  post  mortem  examination,  in  251  by  symptons  evinced  by  the  animal, 
and  in  4  it  was  uncertain. 

In  120  cases  the  wounds  were  severe  and  on  uncovered  parts  of  the  body, 
in  485  moderately  severe,  in  103  slight  (having  been  inflicted  on  the  limbs 
through  thick  clothing). 

In  524  cases  the  persons  presented  themselves  for  treatment  within  a 
week  after  the  bite,  in  122  cases  within  two  weeks,  in  44  within  three  weeks, 
in  14  within  four  weeks,  and  in  4  a  month  or  more  after  the  bite. 

Classified  by  months  of  the  year,  they  were  as  follows: 


Months. 


January.. 
February 
March  ... 

April 

May 

June 


Persons 
bitten. 


34 

40 
59 

84 
76 
82 


Months. 


July 

August 

September 
October ... 
November . 
December  . 


Persons 
bitten. 


117 
91 
40 
43 
35 
31 


Total. 


732 


The  duration  of  treatment  was  in  the  majority  of  the  cases  three  weeks. 
The  total  number  of  persons  who  underwent  the  complete  treatment  was 
704,  with  9  deaths,  or  a  mortality  of  0.71  per  cent. ;  of  these  4  died  during 
the  treatment,  and  5  after  its  completion. 

At  the  Odessa  Bacteriological  Station,  during  the  year  1893,  there  were 
treated  793  persons.  Of  those  who  had  passed  through  the  treatment,  and 
could  be  said  to  have  died  in  spite  of  the  preventive  inoculations,  there 
were  two  deaths  or  a  mortality  of  only  0.26  per  cent.  However,  4  of  the  793 
delayed  in  commencing  the  inoculations,  and  died  during  the  treatment 
and  should  not  be  included  in  the  deaths.  If  these  four  were  included  the 
number  of  deaths  would  have  been  6,  and  the  mortality  would  have  been 
0.76  per  cent.  Of  the  793  persons  admitted  for  treatment,  83  were  batten 
by  animals  proved  experimentally  to  be  rabid;  253  by  animals  pronounced 
rabid  after  veterinary  or  post-mortem  examination;  439  were  bitten  by  ani- 
mals suspected  of  rage;  and  18  were  persons  who  had  been  subject  to  the 
danger  of  contagion  while  attending  sick  persons  or  animals. 

Classifying  these  persons  according  to  age,  96  were  under  five  years  of 
age,  161  from  5  to  10,  211  from  10  to  20,  231  from  20  to  40,  74  from  40  to 
60,  and  20  were  over  60  years  of  age. 


RABIES— HYDROPHOBIA.  37 

In      5  cases  the  animal  causing  the  bite  was  a  wolf. 


In  710     " 

a 

a 

a 

a         a 

"     "  dog. 

In    56     " 

a 

a 

a 

a         u 

"     "  cat. 

In      2     " 

ic 

a 

a 

K            11 

"     "  calf. 

In      1     " 

a 

a 

a 

u         a 

"     "pig- 

In      1     " 

a 

a 

« 

«          u 

"     "  horse. 

In  18  cases 

there 

was 

possibility 

of  infection  while  tending 

sick  persons  or 

animals. 

At  Budapesth,  Hungary — Professor  Hogyes,  Director. 

From  April  15,  189.0,  to  April  14,  1891,  the  number  of  persons  subjected 
to  the  protective  inoculations  was  701,  of  whom  8  died  of  hydrophobia, 
giving  a  mortality  rate  of  1.14  per  cent. 

From  April  15,  1891,  to  April  14, 1892,  there  were  treated  540,  of  whom 
3  died,  giving  a  mortality  of  0.58  per  cent.  The  average  mortality  for  the 
first  two  years  (April  15,  1890,  to  April  14,  1892)  was  0.88  per  cent.  Of 
the  1,241  persons  treated  130  had  been  bitten  on  the  head,  face  or  neck,  of 
these  3,  or  2.30  per  cent,  died;  of  486  bitten  on  the  hands  7,  or  1.64  per 
cent,  died,  and  of  625  bitten  on  the  foot  or  on  the  trunk,  only  1,  or  0.16  per 
cent.  died. 

Official  statistics  of  the  Hungarian  Government  show  that  of  those  who 
were  bitten  during  these  two  years,  who  either  did  not  apply  for  treatment, 
or  applied  too  late  for  successful  treatment,  the  mortality  was  26.8  per  cent. 
When  this  mortality  rate  is  compared  with  the  rate  among  those  treated  in 
time,  the  difference  bears  striking  testimony  to  the  efficacy  of  the  protect- 
ive inoculations. 

During  the  year  ending  April  14,  1893,  there  were  641  persons  treated, 
with  six  deaths  or  a  mortality  of  0.93  per  cent,  during  the  third  year  of  the 
Institute.  In  the  second  year  the  mortality  was  1.16,  and  in  the  first  it 
was  0.56.  During  the  three  years  ending  April  14,  1893,  there  were  1,350 
persons  treated  with  13  deaths,  or  a  mortality  of  0.91  per  cent.  Experience 
showed  that  the  largest  number  of  cases  occurred  in  June,  July,  and  August, 
and  the  least  in  November.  The  total  number  of  persons  who  died  of 
hydrophobia  in  all  Hungary  during  the  same  period  was  103. 

At  Moscow,  Russia — Doctor  Gotdenbach,  Director. 

The  statistics  for  the  year  1892  show  that  907  persons  were  treated,  of 
whom  613  were  males,  and  294  females.  Of  the  907  treated,  178  were 
bitten  by  animals  proved  to  be  rabid,  439  by  animals  pronounced  rabid 
after  veterinary  or  post-mortem  examination,  290  by  animals  probably 
rabid. 

In  769  cases  the  animal  causing  the  bite  was  a  dog. 

"       "    "wolf. 

"    "  cat. 
"       "    "  horse. 
"       "    "  cow. 
"      "    "  pig. 
2  cases  the  bite  was  caused  by  a  human  being. 


In 

45     ' 

In 

70    ' 

In 

11     ' 

In 

8     ' 

In 

2    ' 

In 

2  ca 

38  CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 

Of  the  907  treated,  6  died  notwithstanding  the  treatment,  giving  a 
mortality  of  0.66  per  cent. 

From  June  25,  1886,  to  June  25,  1892,  there  have  been  inoculated  a  total 
of  3,961  persons. 

At  Rio  De  Janerio,  Brazil — Doctor  Agusto  Dos  Santos,  Director. 

From  the  opening  of  the  institute  (February  9,  1888)  to  June  30,  1892, 
1,149  persons  presented  themselves  for  treatment,  but  of  this  number  473 
persons  were  for  various  reasons  rejected.  Of  the  remaining  676  there 
were  511  males  and  165  females;  105  were  treated  in  1888,  90  in  1889, 
158  in  1890,  212  in  1891,  and  81  in  1892. 

In  505  cases  the  bites  were  inflicted  on  uncovered  parts  of  the  body,  and 
in  171  on  covered  parts  of  the  body,  but  the  animal's  teeth  had  penetrated 
the  clothing. 

Cauterization  was  performed  effectually  in  34  cases,  ineffectually  in  392, 
and  there  was  no  cauterization  in  250  cases. 

The  animal  causing  the  bite  in  613  cases  was  a  dog,  in  52  a  cat,  in  2  a 
mule,  and  in  1  a  horse.  In  the  remaining  number  the  treatment  was 
applied  because  of  probable  accidental  infection  while  attending  the  sick 
persons  or  animals. 

In  six  cases  the  bite  was  on  the  head,  in  236  on  the  hands,  in  131  on  the 
arms,  in  201  on  the  legs,  and  in  29  on  the  trunk.  In  ten  cases  the  patient  had 
been  bitten  on  different  parts  of  the  body. 

In  80  cases  the  animal  causing  the  bite  was  proved  experimentally  to  be 
rabid,  in  287  the  animal  was  recognized  rabid  because  of  its  symptoms,  and 
in  300  cases  the  symptoms  of  the  animal  were  so  suspicious  as  to  make  it 
probable  that  the  animal  was  rabid. 

Of  the  total  (676)  commencing  the  inoculations,  15  for  various  reasons 
discontinued  the  treatment,  leaving  661  who  completed  it.  Of  these  661 
only  7  died,  giving  a  mortality  of  1.05  per  cent. 

During  the  period  between  February  9,  1888,  and  August  14,  1889,  there 
were  150  persons  treated.  Of  this  number  141  were  bitten  by  dogs  and 
15  by  cats.  In  19  cases  the  animal  causing  the  bite  was  found  to  be  mad, 
in  67  cases  the  animal  was  recognized  by  clinical  or  veterinary  examination 
to  be  mad  and  in  70  cases  the  animal  was  supposed  to  be  mad. 

From  February  9,  1888,  to  May  19,  1894,  there  were  treated  1,147  per- 
sons, with  only  9  deaths,  or  a  mortality  of  0,78  per  cent. 

At  Saigon,  Cochin  China — Doctor  Calmette,  Director. 

From  April  15,  1891,  to  May  1,1892  (first  year  of  the  institute),  48 
persons  were  treated.  In  16  of  these  cases  the  animal  was  proved  to  be 
rabid,  and  in  all  other  cases  confirmation  of  the  virulence  of  the  bite  was 
received  before  treatment  was  commenced.  Of  the  number  treated  during 
this  period,  16  presented  themselves  on  the  fifth  day  after  being  bitten,  4 
from  the  tenth  to  the  twentieth,  6  from  the  twentieth  to  the  thirtieth,  and 
1  on  the  fortieth  day.  In  spite  of  the  long  delay  before  commencing 
treatment,  only  one  patient  died.  In  all  cases  the  "  intensive  method  " 
was  used. 

Between  May  1,  1893,  and  May  1,  1894,  there  were  49  treated,  with  two 
deaths,  one  of  these  deaths  occurred  immediately  after  the  completion  of 
the  treatment. 


RABIES— HYDROPHOBIA. 


39 


At  this  institute  the  natives  are  treated  at  the  public  expense,  and  every 
native  bitten  by  an  animal  known  to  be  rabid  or  strongly  suspected  of 
rabies,  is  immediately  sent  for  treatment. 

During  the  twelve  months  ending  May  1,  1893  (second  year),  there 
were  62  persons  treated,  with  1  death,  or,  a  mortality  of  1.61  per  cent.  In 
12  cases  the  animal  causing  the  bite  was  proved,  experimentally,  to  be 
rabid,  and  in  the  other  50  cases  the  diagnosis  was  made  clinically  on  the 
statements  of  veterinarians,  and,  in  some  cases,  on  the  statement  of  civil 
or  military  officials.  The  dog  was  the  cause  of  the  bite  in  all  instances 
except  one,  when  the  biter  was  a  man  suffering  from  hydrophobia. 

Since  the  establishment  of  the  institute  (April  15,  1891)  to  May  1,  1893, 
there  were  110  persons  treated,  with  two  deaths,  or  a  mortality  of  1.81  per 
cent. 

At  Padua,  Italy — Doctor  Giovanni,  Director. 

During  the  last  seven  months  of  1890,  Doctor  Giovanni  had  treated  49 
persons  with  no  deaths.  Twenty-three  of  these  were  bitten  by  animals 
proved  experimentally  to  be  rabid,  18  by  animals  recognized  by  clinical  or 
veterinary  examination  to  be  rabid,  and  in  the  remaining  8  by  animals  in 
which  rage  was  only  suspected.  In  all  the  patients  the  bite  had  drawn 
blood,  and  in  nearly  all  the  wound  was  on  an  exposed  part  of  the  body,  in 
30  cases  the  bite  was  on  the  upper  limbs,  and  in  2  the  bite  was  on  the 
head.  Three  months  after  the  last  treatment  in  1890  all  patients  were 
reported  healthy. 

In  the  year  1891  there  were  57  persons  treated,  and  in  1892  there  were 
48.     No  death  occurred  in  either  year. 


At  Buenos  Aires,  Argentine    Republic — Doctor  D.  J.   Davel,  Director. 

The  institute  at  Buenos  Ayres  was  the  first  of  its  kind  in  North  or  South 
America,  and  the  fifth  in  the  entire  world.  The  first  inoculations  were 
made  September  4,  1886,  in  the  presence  of  a  distinguished  assembly,  com- 
posed mostly  of  medical  men  and  students.  From  September  4,  1886,  to 
September  6,  1894,  there  were  1,981  cases  treated,  with  14  deaths,  or  a 
mortality  of  0.70  per  cent.  The  following  are  the  facts  for  the  several 
years: 


Years. 

Nnmber 
treated. 

Deaths. 

Death-rate 
per  cent. 

1886 

19* 

77 
236 
259 
254 
285 
313 
327 
211f 

0 
1 
1 
5 
3 
1 
0 
2 

1 

.00 

1.29 

.42 

1.93 

1.18 

1.35 

.00 

.61 

.47 

1887 

1888 

1889. _. 

1890 

1891 

1892 

1893 

1894 

Total _. 

1,981 

11 

0.70 

*  From  September  4  to  December  31. 1886. 
t  From  January  1  to  September  6, 1894. 


40  CHARLOTTE  SANITARY   CONVENTION,  NOVEMBER,  1894. 

Of  the  14  fatal  cases  one  person  sought  treatment  36  days  after  receiv- 
ing the  bite,  several  delayed  26  days,  one  12  days;  and,  considering  these 
long  delays,  the  great  fatality  cannot  be  attributed  to  the  inefficiency  of 
the  method  of  treatment.  Again,  in  some  of  the  14  cases  death  was  not 
produced  exclusively  by  rabies,  but  other  serious  complications,  and  the 
gravity  of  the  bite,  were  causative  factors. 

In  683  cases  the  animal  causing  the  bite  was  proved,  experimentally,  to 
be  rabid;  and  of  these  only  4  died.  It  is  estimated  that  thirty  per  cent,  of 
these  683,  or  204  persons,  would  have  died  had  they  not  presented  them- 
selves for  the  treatment.  Of  the  total  number  treated  (1^981)  there  would 
have  resulted,  at  the  same  ratio,  594  deaths. 

Of  the  825  persons  treated  during  the  period  between  September,  1886, 
to  December  31,  1890,  the  mortality  among  those  bitten  by  animals  proved, 
experimentally,  to  be  rabid  was  2.74  per  cent.,  among  those  in  which  the 
animals  were  recognized  by  veterinarians  to  be  rabid  0.S5  per  cent.,  and 
among  those  bitten  by  animals  suspected  of  rage  it  was  0.59  per  cent. 

At  Bucharest — Professor  Babes,  Director. 

At  the  meeting  of  the  International  Medical  Congress  in  Berlin  (1890) 
Babes  reported  that  in  the  Pasteur  Institute  at  Bucharest  about  three 
hundred  persons  are  inoculated  yearly,  with  a  mortality  of  about  0.40  per 
cent,  in  cases  bitten  by  dogs,  most  of  which  were  demonstrated  to  be  rabid 
by  inoculation  experiments  made  at  the  institute. 

At  Naples — Doctor  Calabrese,  Director. 

From  August,  1886,  to  April,  1894,  there  were  inoculated  1,000  persons. 
Of  this  number  291  were  bitten  by  animals  proved  to  be  rabid,  486  by 
animals  recognized  by  clinical  or  veterinary  examination  to  have  been 
rabid,  the  remaining  223  were  bitten  by  animals  only  suspected  of  rage. 
The  number  of  deaths  was  8,  or  a  mortality  of  0.80  per  cent. 

At  Havana,  Cuba  (Bacteriological  Laboratory) — Doctor  Acosta,  Director. 

This  is  reported  to  have  been  the  first  place  in  the  tropics  where  the 
Pasteur  method  was  tried.  From  April  15,  1887,  to  December  31,  1889, 
there  were  306  persons  treated,  with  two  deaths,  or  a  mortality  of  0.65  per 
cent.  In  the  first  105  persons  treated  no  deaths  resulted,  although  they 
had  been  bitten  by  dogs  proved  experimentally  or  clinically  to  have  been 
mad.  Notwithstanding  some  700  persons  applied  for  treatment  during 
this  period,  only  the  306  were  accepted. 

At  Saint  Petersburg — Doctor  M.   W.  Kraiouchkine,  Director. 

This  antirabic  station  was  established  July  13,  1886,  and  was  a  gift  of 
his  Highness,  Prince  Alexandre  Petrovitch  d'Oldenbourg,  and  was 
first  installed  at  the  Veterinary  Infirmary  of  the  Regiment  of  Horse 
Guards,  but  was  in  1892  transferred  to  the  Imperial  Institute  of  Experi- 
mental Medicine,  which  institute  was  also  founded  by  his  Highness. 

During  the  five  years  ending  July  13,  1891,  1,256  persons  presented 
themselves  for  treatment.  Of  this  number  394  were  rejected  for  various 
reasons  and  23  discontinued  the  treatment,  leaving  839  who  completed  the 
treatment. 


RABIES— HYDROPHOBIA. 


41 


The  following  table  shows,  by  years,  the  number  treated  during  the  five 
years  ending  July  13,  1891 : 


Years. 

1886  (last  six  months). 

1887. 

1888 

1889 

1890 

1891  (first  six  months). 

Total 


Persons  treated. 
137 
200 
184 
106 
142 
70 


839 


Of  the  839  persons  treated  there  were  391  men,  192  women,  and  256 
children  (under  fifteen  years  of  age). 

The  largest  number  of  persons  were  bitteu  during  the  months  of  June, 
July  and  August.  This  may,  however,  be  due  to  the  fact  that  the  peasants 
were  the  class  of  people  most  commonly  bitten  and  the  summer  months 
is  the  season  of  the  year  when  they  pass  most  of  their  time  in  the  fields. 
The  following  table  will  classify  the  bites,  by  months  of  the  year: 


Months. 


January  .. 
February 
March  ... 

April 

May 

June 


Persons 
bitten. 


66 
74 
62 
68* 
45 
92 


Months. 


July 

August 

September 
October  ... 
November. 
December  . 


Persons 
bitten. 


116 
88 
73 
63 
56 
36 


Total. 


839 


The  majority  of  persons  bitten  presented  themselves  within  one  week 
after  being  bitten;  and,  as  this  is  an  important  factor  in  the  success  of  the 
inoculations,  the  following  table  is  presented: 

Those  presenting  themselves  within  3  days  after  the  bite,  213 

"       1  week    "      "       "       281 

"      2  weeks  "      "       "       213 

"  "  "       8     "       "       "       "         80 

ct  t<  u  u  A         a  «  u  u  on 

"      later  than  1  month "       "       "         15 


Total,        -------  839' 

In  735  cases  the  animal  causing  the  bite  was  a  dog. 

"cat. 
"  wolf. 
"  horse. 
"  cow. 
"  fox. 

839 


In 

75 

a            a 

In 

16 

cc            a 

In 

4 

(<            it 

In 

3 

a            a 

In 

6 

it             a 

42 


CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 


Of  the  839  treated,  222  were  bitten  on  covered  parts,  and  the  remaining 
617  are  divided  as  follows: 

Those  bitten  on  the  head 54 

"  "       "     "    superior  members 487 

"       "     "     inferior        "  33 

"  "        "     different  parts  of  the  body 43 


617 


In  422  cases  the  animal  causing  the  bite  was  proved  to  be  rabid,  and  the 
mortality  was  3.08  per  cent. ;  in  240  cases  the  animal  was  recognized  by 
clinical  or  veterinary  examination  to  be  rabid,  and  the  mortality  was  1.25 
per  cent.;  and  in  177  cases  where  the  animal  could  only  be  suspected  of 
rage,  the  mortality  was  3.38  per  cent.  The  general  mortality  was  2.62  per 
cent. 

The  largest  number  of  deaths  occurred  among  those  patients  presenting 
multiple  bites  on  the  head  or  other  parts  of  the  body.  No  deaths 
occurred  in  the  222  cases  where  the  bite  was  on  covered  parts;  but,  in  the 
617  cases  where  the  bite  was  on  uncovered  parts,  there  were  22  deaths  or  a 
mortality  of  3.56  per  cent. 

In  the  year  1892  there  were  288  persons  presented  for  treatment.  Of 
this  number  66.  were  rejected  for  various  reasons,  and  11  discontinued  the 
treatment,  thus  leaving  211  persons  who  completed  the  inoculations.  Of 
this  number  109  were  men,  43  women,  and  59  children  (under  15  years  of 
age). 

The  following  table  classifies  the  bites  by  months  of  the  year: 


Months. 


January  .. 
February 
March  ... 

April 

May 

June 


Persons 
bitten. 


18 
9 
13 
28 
19 
22 


Months. 


July 

August 

September 
October  ___ 
November. 
December.. 


Persons 
bitten. 


15 

22 

21 

15 

7 

6 


Total. 


195 


Those  presenting  themselves  within  3  days  after  the  bite,     25 


it 

it 

CI 

a 

1  week    "      " 

it 

71 

(i 

it 

it 

ci 

2  weeks   "       " 

a 

63 

(S 

li 

(( 

it 

3     "         "      " 

a 

29 

it 

tt 

11 

(i 

4     it        n      it 

(C 

14 

it 

it 

Total 

it 

later  than  1  month  "       " 

(( 

9 

211 

In  181 

cases 

the 

animal  causing 

the  bite 

was  a  dog. 

In    17 

u 

u 

(< 

(i      << 

"    "  cat. 

In      8 

(( 

<( 

.  a 

a        tt 

"    "wolf. 

In      3 

ft 

tl 

it 

a        it 

"    "  horse. 

In      1 

(1 

b( 

u 

<<        <( 

"    "  guinea  pig 

experimental 

In      1 

l< 

(( 

it 

«<        tt 

"    "  mouse 

animals. 

RABIES— HYDROPHOBIA.  43 

Of  the  211  persons  treated,  68  were  bitten  on  covered  parts,  no  death 
occurring.     The  remaining  143  were  bitten  as  follows: 

Those  bitten  on  the  head 16 

"          "       "  superior  members - 108 

"        "   inferior           "        _• 11 

"          "       "  different  parts  of  the  body 8 

143 

Of  the  211  persons  treated  during  the  year  1892,  three  died,  giving  a 
mortality  of  1.42  per  cent.  » 

At  Vienna — Professor  Paltauf,  Director. 

Antihydrophobia  inoculations  are  being  given  at  the  Rudolph  Stiftung 
Hospital  at  Vienna.  The  inoculations  are  performed  daily  between  10 
and  11  a.  m.  At  present  there  is  no  charge  for  the  treatment,  but  it  is 
understood  that  the  charge  for  such  treatment  is  now  under  consideration. 

Preventive  inoculations  have  been  given  by  Doctor  Ullmann.  In  one 
year  122  persons  were  treated,  within  10  days  after  the  bite,  and  only  3 
died,  or  a  mortality  of  2.46  per  cent.  During  the  same  period  several 
others  were  bitten  by  the  same  dog  causing  the  bite  of  some  of  the  122 
treated.  These  persons  did  not  undergo  the  treatment  and  have  since 
died. 

At  Chicago — Doctor  A.  Lagorio,  Director. 

During  the  period  between  July  2,  1890,  and  February  9,  1894,  366 
persons  were  treated,  and  are  classified  as  follows: 

Of  the  total  number  treated  104  were  bitten  by  animals  recognized  to  be 
rabid  by  experimental  proof,  or  by  death  of  other  persons  or  animals  bit- 
ten by  the  same  animal;  126  were  bitten  by  animals  recognized  to  be  rabid 
by  the  symptoms  of  the  disease;  and  72  were  bitten  by  animals  strongly 
suspected  of  rabies. 

Dogs  caused  the  bite  in  341  cases,  horses  in  9,  cats  in  7,  skunks  in  5, 
wolves  in  2,  a  mule  in  1  case,  and  a  pig  in  1  case. 

Two  deaths  were  reported  among  the  above  mentioned  patients,  giving 
a  mortality  of  only  0.54  per  cent. 

In  123  of  the  cases  the  animal  causing  the  bite  was  proved  to  be  rabid,, 
in  160  the  animal  was  recognized  to  be  rabid  by  the  symptoms  of  the 
disease  shown  during  life,  and  in  83  cases  the  animal  causing  the  bite  was. 
strongly  suspected  of  rabies. 

Besides  the  366  persons  who  were  treated,  372  others  were  rejected  for 
various  reasons. 

[Doctor  Lagorio  records  the  case  of  a  five-year-old  boy,  subject  to 
epilepsy,  who,  on  account  of  the  bite  of  a  dog,  was  treated  at  the  labora- 
tory in  August,  1890,  and  who  has  not  only  never  suffered  bad  consequence 
from  the  bite,  but  recovered  from  the  epilepsy  as  well.  Similar  cases  and 
results  have  been  noticed  at  other  institutes,  although  I  believe  that 
Doctor  Lagorio  claims  priority]. 

At  Calcutta,  Bengal — A.  Renter,  Director. 

A  Pasteur  Institute  was  successfully  inaugurated  on  January  30,  1894, 
in  the  presence  of  a  large  company.  After  the  ceremony  subscriptions  to 
a  considerable  amount  were  promised. 


44  CHARLOTTE   SANITARY  CONVENTION,  NOVEMBER,  1894. 

At  Milan,  Italy — Doctor  Remo  Segre,  Director. 

This  institute  was  established  in  1890,  by  subscription  from  local  busi- 
ness houses.  During  the  years  1890  and  1891,  238  cases  were  treated. 
Of  these  108  were  bitten  by  animals  proved  experimentally  to  be  rabid 
(two  deaths),  121  by  animals  recognized  by  medical  men  or  veterinary 
surgeons  to  have  been  rabid  (two  deaths),  and  9  were  bitten  by  animals 
suspected  of  rage  (no  death).  Thus  out  of  238  treated  there  occurred  4 
deaths,  or  a  mortality  of  1.68  per  cent. 

At  Constantinople,  Turkey — Doctor  Zoeros,  Director. 

Between  May  1,  1887,  and  March  1,  1889,  41  persons  were  treated,  with 
no  death  resulting.  Of  these  12  had  been  bitten  by  animals  proved 
experimentally  to  be  rabid,  26  by  animals  recognized  rabid  by  medical  men, 
veterinary  surgeons,  or  other  competent  persons,  and  3  by  animals  in 
which  rabies  was  only  suspected. 

Value  of  the  Dog. 

That  there  is  about  one  dog  to  every  fourth  family,  and  many  more  dogs 
than  is  absolutely  necessary,  is  a  fact  recognized  by  nearly  every  citizen  in 
the  United  States  and  probably  by  the  great  majority  of  people  in  the 
world;  however,  that  species  of  animal  is  still  being  propagated,  until 
to-day  an  important  question  is  "  What  is  to  be  done  with  the  dog?" 

Recognizing  the  fact  that  probably  nine-tenths  of  all  the  cases  of  hydro- 
phobia are  due  to  the  bite  of  the  dog,  many  ways  to  prevent  the  occurrence 
of  rabies  have  been  suggested.  One  will  advocate  the  muzzling  of  all  dogs, 
and  another  will  recommend  the  extermination  of  that  animal.  Preven- 
tive inoculation  of  every  dog  has  been  suggested;  but,  as  this  has  not  been 
generally  tried,  it  does  not  at  present  seem  entirely  practicable. 

Muzzling  is  effective  when  fully  enforced,  but  experience  has  shown 
that  it  is  difficult  to  keep  muzzled  every  dog.  It  is  stated,  however,  that 
in  Germany  where  muzzling  is  generally  enforced  there  are  very  few  cases 
of  hydrophobia. 

In  cities  the  system  of  "  catching  and  killing  "  stray  dogs  has  proved 
efficacious  indeed  and  every  year  there  are  thousands  of  stray  dogs  caught 
and,  if  not  claimed  within  a  certain  period,  they  are  killed  by  various 
methods,  such  as  drowning,  smothering  in  a  vacuum  chamber,  killing  by 
poisonous  gasses,  et  cetera.  This  seems  cruel,  but  something  must  be 
done  to  rid  the  country  of  the  over-numerous  dogs. 

While  the  protection  of  human  beings  is  of  primary  importance,  there 
is  still  another  consideration  of  no  slight  importance,  namely,  the  destruc- 
tion of  property.  It  is  not  uncommon  to  have  it  reported  that  a  mad  dog 
has  killed  or  given  rabies  to  such  valuable  property  as  horses,  cows,  sheep, 
chickens,  et  cetera,  which  usually  means  death  to  the  animals  infected. 
While  there  are  many  instances  of  destruction  of  stock,  the  most  notable 
I  now  have  in  mind  is  the  outbreak  of  rabies  near  Fowler ville,  Michigan, 
in  March,  1888.  It  is  reported  that  one  dog  caused  the  death  of  some  six 
cows,  nine  horses,  and  about  seventy-five  chickens.  The  dog  also  attacked 
two  children;  but,  as  the  bite  was  on  parts  thoroughly  covered  and  there 
was  no  abrasion  of  the  skin,  the  children  did  not  have  hydrophobia. 
Nearly  all  of  the  mentioned  animals  died  of  rabies.     It  is  of  common 


RABIES— HYDROPHOBIA. 


45 


occurrence  to  Hear  of  outbreaks  of  rabies  of  more  or  less  magnitude  occur- 
ring in  different  parts  of  the  world.  In  fact  they  are  so  frequent  that  it 
would  be  useless  to  try  to  enumerate  them;  medical  journals  and  statistics 
abound  with  them. 

The  following  table  will  give  a  vivid  idea  of  the  enormous  money-loss 
by  dogs  in  the  state  of  Ohio  for  the  years  1880-1893.  Through  the  kind- 
ness of  the  Secretary  of  State's  office  at  Columbus,  I  have  been  able  to 
secure,  and  have  tabulated  the  following  facts: 


NUMBER  AND  VALUE  OF  SHEEP  KILLED  AND  INJURED  BY  DOGS,  IN  OHIO.  FOUR- 
TEEN YEARS,  1880-93;  AND  NUMBER  OF  MILCH  COWS  COMPARED  WITH  NUMBER 
OF  DOGS,  IN  OHIO,  FOURTEEN  YEARS,  1880-93. 


Year. 

Sheep  killed  by  dogs. 

Sheep  injured  by  dogs. 

Total  No. 

of  milch 

cows. 

Total 
No.  of 
dogs. 

No.  of 
sheep. 

Value  of 
sheep. 

No.  of 
sheep. 

Value  of 
sheep. 

1880 __ 

28,763 
33,297 
34,606 
32,955 
30,327 
21;146 
29,006 
19,029 
31,836 
32,080 
27,862 
25,057 
28,469 
29,915 

$97,277 

122,684 

133,765 

122,788 

104,622 

85,590 

82,183 

84,701 

107,749 

103,531 

100,536 

94,965 

107,181 

107,431 

23,625 
31,609 
31,422 
24,814 
21,685 
18,807 
19,484 
18,283 
25,296 
26,152 
21,823 
17,705 
22,040 
22,840 

$41,671 
60,394 

58,748 
51,188 
43,256 
33,039 
35,098 
51,490 
44,264 
48,503 
42,857 
40,464 
44,509 
46,893 

* 

* 
556,425 
556,425 
576,147 
579,990 
595,524 
580,538 
610,477 
619,483 
595,133 
613,507 
612,766 
600,463 

121,656 

* 

* 
214,794 
160,072 
160,018 
168,398 
162,809 
162,644 
155,446 
148,409 
153,892 
158,142 
152,764 

1881 

1882. 

1883. 

1884 

1885 

1886 

1887 

1888. __ 

1889 

1890 

1191 

1892 

1893. _ 

403,348 

$1,456,003 

325,585 

$642,374 

*  No  statistics  reported  to  the  Secretary  of  State. 

The  Agricultural  Statistics  of  Ohio  for  the  last  ten  years  show  that  on 
an  average  every  year  there  are  about  600,000  milch  cows  and  about  150,- 
000  dogs  existing  in  the  state,  or  about  one  dog  to  every  four  cows.  These 
facts  plainly  show  the  prevalence  of  the  dog.  The  dog  is  probably  as 
numerous  in  other  states.  Considering  the  comparative  value  of  the  two 
animals,  it  does  not  seem  possible  that  the  citizens  of  any  state  will  keep 
an  animal  which  is  of  so  little  value,  and  no  small  expense,  as  the  average 
dog.  Every  one  knows  the  value  of  a  milch  cow,  but  there  are  people  who 
rather  part  with  a  whole  herd  of  milch  cows  than  to  part  with  their  pet 
dog  even  though  the  dog  be  the  worst  kind  of  a  mongrel. 

From  the  foregoing  table  it  will  be  observed  that  in  the  state  of  Ohio 
alone,  during  the  fourteen  years  (1880-1893)  401,348  sheep  were  killed 
and  325,585  were  injured,  giving  an  appalling  money-loss  of  $2,098,377. 
Supposing  such  a  statement  were  made  for  the  whole  world,  and  the  loss 
of  human  life  should  be  included,  would  not  the  facts  be  a  powerful  argu- 
ment for  less  dog,  less  sacrifice  of  property  and  less  sacrifice  of  human 
life? 


46  CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 

To  counterbalance  the  immense  loss  of  property  and  human  life  every 
year  there  is  provided  in  many  cities  and  countries  a  dog-tax  or  license 
which  is  a  revenue  to  the  local  funds  amounting  to  millions  of  dollars.  In 
Chicago  the  dog-tax  without  regard  to  the  sex  of  the  animal  is  two  dollars 
per  year,  the  number  of  licenses  issued  each  year  averaging  from  34,000  to 
35,000,  which  means  that  in  Chicago  alone  there  is  turned  into  the  city 
treasury  a  sum  averaging  about  $75,000  yearly. 

Of  course  the  number  licensed  does  not  cover  all  the  dogs,  because  they 
are  "caught  and  killed,"  and  many  are  never  licensed.  I  presume  a  con- 
servative estimate  would  be  that  in  cities  where  there  is  an  effective  dog 
ordinance  about  three-fourths  of  the  dogs  are  licensed;  while  in  smaller 
towns  and  cities  about  one-tenth  would  be  a  fair  estimate  of  the  number 
licensed. 

In  Detroit  the  ordinance  provides  a  license  of  $1.00  for  male  and  $2.00  for 
female  dogs,  with  an  additional  ten  cents  each  for  the  tag.  During  the 
four  years,  1890-93,  there  were  8,507  licenses  issued  with  a  revenue  to  the- 
city  of  $9,574.70.  But  as  Detroit  claimed  about  250,000  citizens,  there 
ought  to  have  been  in  the  four  years  at  least  75,000  dogs  licensed,  with  a 
revenue  of  at  least  $100,000  instead  of  only  $9,57470.  It  is  evident, 
the  dog  ordinance  is  not  being  rigidly  enforced. 

I  am  informed  that  there  is  no  law  or  ordinance  in  Philadelphia  compell- 
ing dogs  to  be  registered  or  providing  for  a  dog-tax.  There  is,  however,  an 
ordinance  requiring  all  dogs  running  at  large  to  be  muzzled,  and  if  any 
are  found  unmuzzled,  they  are  taken  up  by  the  et  dog  catchers "  and 
turned  over  to  the  pound-master  where  they  may  be  redeemed  by  paying: 
$2.00.  If  not  redeemed  they  are  killed  by  some  kind  of  gas.  In  1891 
there  were  6,052  dogs  captured,  and  4,829  were  killed;  the  redemption 
money  paid  to  the  city  was  $2,128.  By  paying  $1.25  at  the  office  of  the 
Clerk  of  Quarter  Sessions,  the  owner  may  receive  a  life-long  registration 
certificate  for  his  dog  which  makes  the  animal  the  personal  property  of 
the  owner.  This  certificate  may  be  transferred  by  paying  the  sum  of  12 
cents.  From  September,  1860,  to  November  22,  1894,  about  8,519  dogs 
where  registered  becoming  the  personal  property  of  the  owner. 

In  Bavaria  from  1863  to  1876  the  deaths  from  hydrophobia  ranged  from 
14  to  31  each  year.  A  striking  contrast  are  the  statistics  for  the  first  seven 
years  (1893-1889)  of  the  enforcement  of  the  muzzling  order  which  pro- 
vides for  the  killing  of  stray  dogs.  During  this  period  of  enforcement  of 
the  order,  only  three  deaths  have  occurred  in  a  population  of  five  and  one- 
half  millions  of  people. 

During  the  month  of  August,  1889,  the  police  in  London  seized  3,290 
stray  dogs;  47  either  rabid  or  supposed  to  be  were  killed  on  the  streets;  19 
were  proved  by  post-mortem  examination  to  be  rabid;  and  1,681  persons 
were  reported  to  have  been  bitten  by  dogs.  In  May,  1894,  the  London 
police  captured  2,161  stray  dogs,  and  148  persons  were  reported  to  have 
been  bitten  by  vicious  dogs. 

There  are  reported  to  be  150,716  dogs  in  the  Seine  Department,  France. 
In  1892  the  municipal  tax  was  collected  from  the  owners  of  130,716  dogs, 
and  in  20,000  the  tax  was  avoided. 

A  vicious  dog  may  cause  his  owner  a  considerable  expense  as  well  as 
trouble.  A  dog  that  destroys  property  may  be  an  expensive  pet.  In 
France  only  a  few  years  ago  a  man  was  bitten  by  a  vicious  dog  from  which 
he  received  a  permanent  injury.     He  instituted  an  action  for  damages  and 


RABIES— HYDROPHOBIA.  47 

the  courts  awarded  him  a  judgment  of  11,000  francs  (about  $2,500)  and 
ruled  that  the  owner  of  a  dog  was  responsible  for  any  damages  done  by  the 
animal.  9 

The  dog,  and  especially  the  house  dog,  may  be  a  source  of  contagium  in 
infectious  diseases.  The  Iowa  State  Board  of  Health  has  recently  (Sep- 
tember, 1894)  reported  a  death  from  diphtheria  in  which  the  source  of 
infection  was  traced  to  a  pet  dog.  Doctob  Stiles,  of  the  Bureau  of  Ani- 
mal Industry  tells  how  animal  parasites  dangerous  to  man,  such  as  the 
tongue-worm  (Linguatula  rhinaria)  the  tape-worm  (  Tenia  echinococcus), 
•et  cetera,  are  conveyed  to  man  by  way  of  the  pet  dog. 

RULES  AND  REGULATIONS  SHOULD  BE  FRAMED  AND  PUBLISHED. 

One  of  the  most  efficient  means  employed  for  the  restriction  of  the 
•spread  of  rabies  is  a  set  of  rules  which  shall  regulate  the  action  and  move- 
ments of  animals  infected  with  the  disease.  Each  local  board  of  health 
should  frame  and  publish  (in  accordance  with  state  laws)  rules  which 
would  enable  the  health  officer  to  act  promptly  upon  the  appearance  of 
a  case  of  this  disease  so  dangerous  to  the  public  health  and  life.  If  a 
health  officer  is  obliged  to  wait  until  the  local  board  can  be  called  together, 
the  disease  may  have  been  allowed  to  spread,  instead  of  restricting  it  to 
the  first  case. 

On  the  occurrence  of  a  case  of  rabies  the  facts  should  be  reported  to  the 
local  health  officer,  and  promptly  restricted  by  him  in  accordance  with  Act 
137,  Laws  of  1883.  The  health  officer  should,  in  compliance  with  Sections 
5  and  6,  Act  125,  Laws  of  1889,  report  the  fact  to  the  president  bf  the  State 
Live  Stock  Commission,  who  at  present  resides  at  Stanton,  Michigan.  The 
local  health  authorities  should  isolate  the  animal  or  animals  and  keep  them 
so,  until  they  are  taken  care  of  by  the  State  Live  Stock  Commission  or 
State  Veterinarian;  but,  under  no  circumstance  should  the  local  health 
authorities  fail  to  guard  the  public  health  and  life.  Whether  in  man  or 
animals  the  full  facts  regarding  the  outbreak  of  the  disease  should  be 
reported  to  the  Secretary  of  the  State  Board  of  Health,  at  Lansing. 

In  cities  the  "  Dog  Ordinance  "  generally  regulates  the  action  of  animals 
most  likely  to  be  infected  with  rabies.  Every  city  should  be  equipped 
with  an  efficient  ordinance  and  should  demand  its  strict  enforcement.  An 
ordinance  may  be  ever  so  efficient,  but  if  not  enforced  is  useless,  and  the 
stray  and  ownerless  dogs  will  be  permitted  to  roam  about  the  city  to 
become  infected  with  rabies  and  transmit  the  disease  to  human  beings. 
The  following  is  an  ordinance  in  force  in  a  certain  city  of  the  U.  S.  which 
it  seems  to  me  no  city  would  make  a  mistake  by  copying: 

Be  it  ordained  by  the  City  Council  of  the  City  of ; 

Section  1. — Every  owner  of,  or  person  who  harbors  or  keeps,  a  dog  within  the  limits  of  this  city,  shall 
report  to  the  City  Collector  annually,  within  thirty  days  after  the  first  day  of  May  in  each  year,  his  or  her 
name  and  address,  and  shall  give  the  name,  breed,  color  and  sex  of  each  and  every  dog  owned  or  kept  by 
such  person,  and  shall  pay  to  such  officer  the  sum  of  two  dollars  for  each  and  every  dog,  and  cause  such 
dog,  or  dogs,  to  be  registered  for  license  in  the  office  of  the  City  Clerk,  who  shall  furnish  the  owner  or 
keeper  of  same  with  a  license  tag. 

Section  2.— Every  dog  shall  be  provided  by  its  owner  or  keeper,  with  a  leather  or  chain  collar,  to  which 
a  license  tag  shall  be  securely  fastened,  and  every  dog  shall  also  be  muzzled,  if  so  ordered,  as  hereinafter 

provided.    No  dog  shall  be  permitted  to  remain  within  the  limits  of  the  City  of ,  unless  the 

■owner,  or  keeper  thereof,  shall  have  caused  such  dog  to  be  registered  and  licensed,  and  provided  with 
such  collar  and  tag,  and  be  muzzled,  if  so  ordered,  and  any  owner,  or  keeper,  of  a  dog  failing  to  provide 


48  CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 

such  collar,  tag  or  mnzzle,  if  required,  shall  be  subject  to  a  fine  of  five  dollars  for  every  such  dog  so- 
unprovided,  to  which  fine  shall  be  added,  if  unlicensed,  the  amount  of  the  license  tax,  and  costs,  if  any,, 
incurred. 

Section  8.— The  City  Clerk  shall  keep  a  complete  registry^  in  a  book  to  be  kept  for  that  purpose,  of  all 
licensed  dogs,  describing  same  by  name,  breed,  color  and  sex,  and  shall  also  enter  the  name  and  address 
of  the  owner  or  keeper  as  given,  and  the  number  of  the  city  license  tag. 

He  shall  provide,  each  and  every  year,  such  number  of  metal  tags  as  may  be  necessary  (the  shape  to  be 

changed  each  year)  having  stamped  thereon  the  year  for  which  the  tax  is  paid,  the  letters D.  T.,  and 

also  the  number  of  the  tag,  and  it  shall  be  the  duty  of  the  City  Clerk  to  deliver  one  of  such  metal  tags, 
number  to  correspond  with  the  number  of  the  registry  of  the  dog,  to  the  person  having  paid  the  tax  upon 
any  such  dog. 

The  City  Clerk  shall  also  send  a  duplicate  of  such  registry  to  the  Pound-master,  who  shall  record  the 
same  in  a  book  to  be  kept  by  him  for  that  purpose,  and  such  record  shall  be  open  to  public  inspection. 

Section  4. — Whenever  the  Mayor  of  this  city  shall  deem  it  necessary,  he  shall  issue  an  order  prohibit- 
ing for  a  certain  time  therein  specified  all  dogs  from  running  at  large  on  any  street,  alley,  or  other  public 
place,  in  this  city,  unless  such  dog  be  securely  muzzled,  or  led  by  a  line  or  chain,  so  as  to  effectually  pre- 
vent them  from  biting  any  person  or  animal,  which  order  shall  be  published  in  a  daily  newspaper  of  gen- 
eral circulation  in  the  City  of . 

Section  5.— It  shall  be  the  duty  of  the  Superintendent  of  Police,  his  assistants,  and  of  all  the  police- 
men of  the  City  of ,  to  take  up  and  impound  in  such  suitable  place,  or  places,  as  may  be 

designated  by  the  Mayor  (of  which  place  or  places,  notice  shall  be  given  by  posting  a  card  or  notice  in 
some  conspicuous  place  in  the  office  of  the  Chief  of  Police,  and  in  the  office  of  the  City  Collector,  and 

also  by  publication,  of  such  place  or  places,  in  some  daily  newspaper  of  the  City  of ,  of  general 

circulation,  to  be  designated  by  the  Mayor),  any  dog  found  running  at  large  in  the  City  of , 

contrary  to  the  provisions  of  any  ordinance,  or  of  any  order  issued  by  the  Mayor. 

Section  6.— The  City  Pound- master  shall,  immediately  upon  receiving  any  dog  at  the  pound,  make  a 
complete  registry  of  same,  enter  the  breed,  color  and  sex,  and  whether  licensed  or  not,  if  ascertained,  and 
if  licensed,  he  shall,  if  known,  enter  the  name  and  address  of  the  owner  or  keeper,  and  the  number  of  the 
license  tag,  if  any,  and  shall  keep  impounded  licensed  dogs  separate  from  unlicensed  dogs. 

A  list  of  all  licensed  dogs  impounded,  if  any,  shall  be  immediately  sent  to  the  City  Clerk,  for  entry,  by 
the  Pound-master,  who  shall  also  forthwith  give  notice,  through  the  postoffice,  to  the  owners  or  keepers 
of  such  licensed  dogs,  of  their  being  impounded. 

Section  7. — For  every  dog  taken  up  and  confined  in  the  dog  pound,  as  provided  in  this  ordinance,  for 
which  no  license  tax  has  been  paid,  a  redemption  fee  of  three  dollars,  together  with  the  amount  of  the 
tax,  shall  be  paid  to  the  City  Collector  for  the  use  of  the  city  ;  and  upon  procuring  a  certificate  from  the 
City  Collector,  stating  that  said  amount  has  been  paid,  and  paying  to  the  Pound-master  for  taking  up 
such  dog  the  further  sum  of  fifty  cents,  and  the  cost  of  keeping  such  dog,  not  to  exceed  twenty-five  cents 
per  day,  and  cost  of  advertising,  if  any,  as  hereinafter  provided,  the  owner  or  keeper  thereof,  within  five 
days  after  the  impounding,  or  any  other  person,  after  five  days,  shall  be  entitled  to  redeem  such  dog,  and 
if  such  dog  shall  not  be  redeemed  within  five  days  after  being  taken  up,  such  dog  shall  be  destroyed  by 
the  Pound-keeper,  except  that  at  the  expiration  of  the  five  days  allowed  for  the  redemption  of  impounded 
dogs,  the  Pound-master  shall  advertise  immediately  in  a  daily  newspaper  of  general  circulation  in  this 
city,  all  unredeemed  licensed  dogs,  if  known  or  identified  as  such,  and  if  such  dogs  be  not  redeemed  at  the 
expiration  of  the  fifth  day  after  such  advertising,  they  shall  then  be  destroyed. 

Section  8.— Any  dog  for  which  a  license  has  been  paid,  which  may  be  impounded  for  being  at  large 
without  collar  or  tag,  or  without  a  muzzle,  if  required  (if  it  shall  be  made  to  appear  to  the  satisfaction  of 
the  City  Collector  by  the  affidavit  of  the  owner  or  keeper,  or  by  other  sufficient  testimony,  that  a  license 
for  such  dog  was  procured,  and  a  collar  put  around  its  neck,  with  license  tag  attached,  as  provided  in 
this  ordinance,  or  was  muzzled,  as  required  by  any  order  of  the  Mayor,  but  that  such  collar,  tag  or  muzzle 
has  been  accidentally  lost) ,  may  be  redeemed  upon  the  payment  to  the  City  Collector,  for  the  use  of  the 
city,  of  two  dollars,  and  payment  to  the  Pound-keeper  his  charges,  as  provided  in  Section  7  of  this  ordi- 
nance, and  the  City  Collector  may  deliver  to  the  person  redeeming  such  dog,  a  duplicate  license  tag  to 
correspond  with  the  registry,  for  which  duplicate  tag  twenty-five  cents  shall  be  paid. 

Section  9.— It  shall  be  the  duty  of  the  Chief  of  Police,  or  any  police  officer,  to  kill  any  dog  which  may 
be  found  in  the  City  of without  an  owner  or  keeper,  or  found  at  large  contrary  to  any  ordi- 
nance, or  to  any  order  of  the  Mayor :  Provided,  Such  dog  cannot  be  safely  taken  up  and  impounded, 
and  unless  a  dog  cannot  be  safely  taken  up  and  impounded,  it  shall  not  be  lawful  for  any  officer  of  the 


RABIES— HYDROPHOBIA.  49 

City  of ,  or  any  other  person,  to  kill,  or  attempt  to  kill,  any  dog  at  any  other  place  than  the 

dog  pound. 

No  dog  shall  be  subject  to  molestation  under  this  ordinance,  or  under  any  order  of  the  Mayor,  while  on 

the  premises  of  its  owner  or  keeper,  and  any  officer  of  the  City  of •.,  or  other  person,  who  shall 

invade  private  premises  to  capture,  entice,  or  take  any  dog  out,  of  the  enclosure  of  the  possessor  of  such 
dog,  or  who  shall  molest  or  seize  any  dog  while  held,  or  led  by  a  line  or  chain  by  any  person,  or  who  shall 
bring  into  the  city  any  dog,  for  the  purpose  of  taking  up  and  impounding  the  same,  shall,  on  conviction, 
be  fined  in  a  sum  not  less  than  five,  nor  more  than  fifty  dollars. 

Section  10.— If  any  fierce  or  dangerous  dog  shall  be  found  at  large  in  the  streets  of ,  or  upon 

any  public  place,  or  upon  the  private  premises  of  any  other  person  than  the  owner  or  keeper  of  the  dog, 
and  shall  there  annoy  or  endanger  any  person  thereon,  the  owner  or  keeper  thereof  shall  forfeit  and  pay 

to  the  City  of a  sum  of  money  not  exceeding  ten  dollars,  for  the  first  offense  on  the  part  of 

said  owner  or  keeper,  in  permitting  such  fierce  and  dangerous  dog  to  be  at  large ;  and  upon  a  second  or 
further  conviction,  for  the  same  offense,  a  sum  not  exceeding  twenty-five  dollars  ;  and  it  may  be  part  of 
the  sentence,  upon  such  second  conviction,  that  such  fierce  and  dangerous  dog  immediately  be  killed,  and 
this  sentence  shall  be  forthwith  executed  by  the  Chief  of  Police  or  any  police  officer,  for  which^killing 
the  owner  or  keeper  shall  pay  the  further  sum  of  one  dollar,  which  sum  shall  be  included  in  said 
judgment. 

Section  11. — Whenever  complaint  shall  be  made  and  filed  with  any  Justice  of  the  Peace,  or  Police  Mag- 
istrate, setting  forth  that  any  dog  has,  in  any  manner,  disturbed  the  quiet  of  any  person  or  neighborhood, 

or  has  bitten  a  person  within  the  City  of ,  and  that  the  person  so  bitten  was  not  at  the  time 

trespassing  upon  the  person  or  property  of  the  owner  or  keeper  of  such  dog,  the  Justice  of  the  Peace  or 
Police-Magistrate,  shall  issue  a  summons  directed  to  the  Sheriff,  Constable  or  Police  Officer,  which  sum- 
mons shall  be  returnable  forthwith,  and  upon  the  return  of  such  summons  the  Justice  of  the  Peace  or 
Police  Magistrate,  shall  proceed  to  hear  and  determine  the  matter,  and  if  it  shall  appear  that  such  dog 
has  so  disturbed  any  person  or  neighborhood,  or  that  the  person  so  bitten  by  such  dog  was  not  at  the  time 
trespassing  upon  the  person  or  property  of  the  owner  or  keeper  of  such  dog,  the  Justice  of  the  Peace,  or 
Police  Magistrate,  shall  order  said  dog  to  be  removed  or  killed,  and  shall  issue  an  order  to  the  owner,  or 
keeper  of  such  dog,  to  remove  or  kill  it  within  twenty-four  hours  from  the  time  of  receiving  a  copy  of 
such  order. 

The  owner  or  keeper  of  any  such  dog  who  shall  refuse  or  neglect  to  remove  or  kill,  or  cause  such  dog  to 
be  removed  or  killed,  within  twenty-four  hours  after  having  received  a  copy  of  said  order  from  the  Justice 
of  the  Peace,  or  Police  Magistrate,  aforesaid,  shall  be  fined  in  a  sum  not  exceeding  twenty-five  dollars, 
and  the  further  sum  of  twenty-five  dollars  for  every  twenty-four  hours  thereafter  until  such  dog  shall  be 
removed  or  killed. 

It  shall  be  the  duty  of  any  Police  Officer,  or  Constable,  to  kill  said  dog  whenever  it  shall  be  found  at 

large  in  said  City  of r..,  twelve  hours  after  the  service  of  a  copy  of  said  order  on  the  owner  or 

keeper  of  such  dog. 

Section  12.— The  word  dog,  whenever  used  in  this  ordinance,  shall  be  intended  to  mean  a  female  as 
well  as  a  male  dog. 

Section  13.— All  ordinances  or  parts  of  ordinances  inconsistent  with  the  provisions  of  this  ordinance 
are  hereby  repealed. 

ISOLATE   ALL   INFECTED   OE   SUSPECTED   ANIMALS. 

For  the  restriction  of  the  spread  of  rabies  and  hydrophobia,  it  is  important 
that  prompt  action  should  be  taken  with  any  suspicious  animal.  When  a 
dog  or  other  animal  acts  strangely  and  there  is  suspicion  of  madness,  the 
animal  should  be  immediately  confined,  not  killed,  and  kept  under  observa- 
tion for  a  week  or  ten  days.  Have  the  animal  examined  by  a  competent 
physician  or  veterinary  surgeon,  and  if  the  animal  is  rabid  the  characteris- 
tic symptoms  will  soon  be  observed.  Pasteue  says  "  the  animal  will  cer- 
tainly die  within  eight  days.  If  at  the  end  of  that  time  no  symptoms  of 
rabies  have  been  observed,  the  bite  cannot  cause  hydrophobia,  and  there 
is  no  reason  why  the  animal  should  be  destroyed."  If  symptoms  of  rabies 
do  appear  in  the  animal  thus  under  observation,  it  should  be  immediately 
7 


50  CHARLOTTE  SANITARY  CONVENTION,  NOVEMBER,  1894. 

killed;  and,  if  the  animal  has  bitten  a  human  being,  a  small  portion  of  the 
medulla  oblongata  should  be  secured  and  placed  in  a  small  vial  containing 
pure  glycerine  only,  for  use  in  experimental  inoculations  of  other  animals 
to  determine  without  doubt  whether  the  animal  suspected  of  rage  was 
really  rabid. 

If  other  animals  have  been  bitten  by  a  suspicious  animal,  they  should 
likewise  be  confined  until  it  is  proved  whether  or  not  they  are  rabid,  or 
until  the  period  of  incubation*  has  past.  It  is  quite  frequently  the  case 
that  valuable  stock  has  been  bitten  by  animals  not  rabid,  and  it  would  be 
a  useless  destruction  of  property  destroy  such  animals.  Do  not  kill 
an  animal  unless  you  have  good  reason  to  believe  it  is  rabid,  or  unless  it 
is  a  source  of  danger  to  other  animals  and  to  human  life.  Of  course  a  dog 
may  run  mad  when  it  is  quite  impossible  to  secure  the  dog,  and  extremely 
dangerous  for  it  to  run  at  large,  where  shooting  the  animal  may  be  the 
only  safe  way.  In  such  a  case  the  animal  should  not  be  disposed  of  until 
it  is  absolutely  certain  that  no  person  has  been  bitten.  If  a  person  has- 
been  bitten  a  portion  of  the  medulla  should  be  prepared  as  described  above. 
If  a  human  being  has  been  bitten  and  the  animal  is  destroyed  there  is  no 
way  left  to  ascertain  whether  or  not  the  dog  was  really  mad,  and  whether 
the  person  bitten  has  been  inoculated  with  the  virus  of  a  terrible  disease. 

WHAT   SHOULD   BE   DONE   WITH  A   PEBSON   BITTEN. 

It  is  important  that  prompt  measures  be  taken  for  the  care  of  the  patient. 
The  wound  might  be  "  sucked "  and  thoroughly  cleansed  with  a  large 
effusion  of  hot  water,  at  the  same  time  pressing  the  wound  to  cause  any 
liquid,  poison,  et  cetera,  to  ooze  out  and  to  promote  bleeding.  A  solution 
of  boric  acid  would  promote  bleeding  and  aid  in  cleansing  the  wound.  If 
the  wound  is  on  the  leg  or  arm  a  bandage  might  be  placed  between  it  and 
the  heart.  As  soon  as  possible  cauterize  the  wound.  There  are  many- 
cauteries  recommended,  such  as  caustic  potash,  nitrate  of  silver  •(lunar 
caustic),  carbolic  acid,  bichloride  of  mercury,  f  match  of  Paquelin,  et  cetera, 
but  as  these  cauteries,  with  the  exception  of  the  lunar  caustic,  cannot  well 
be  used  except  by  a  physician,  the  white-hot  iron  will  probably  be  most 
available  in  all  cases,  especially  in  places  where  the  physician  is  not  acces- 
sible. Where  a  physician  can  be  called  without  much  delay,  it  is  best  to- 
leave  to  him  the  method,  and  cautery  to  be  used.  Very  little  time  should 
be  lost,  however,  in  calling  a  physician,  because  immediate  action  is  import- 
ant and  the  most  effective  cauterizations  are  those  performed  within  half 
an  hour.  The  hot  iron  can  be  used  by  a  non-professional  person;  while 
the  other  cauteries  require  more  care  in  their  application. 

Cauterization  may  or  may  not  be  effective  in  destroying  the  poisonous 
virus;  but  surely,  in  most  cases,  will  do  no  harm,  and  may  be  the  means 
of  preventing  an  attack  of  hydrophobia.  Most  people  believe,  as  does  the 
illustrious  Pbofessob  Keen,  that  there  is  "  no  treatment  that  will  prove 
effective  in  cases  of  hydrophobia  except  that  of  Pasteur."  Pasteur 
preventive  inoculations  have  been  described  on  preceding  pages  of  this 
paper. 

*  For  period  of  incubation  in  animal  Bee  page  27  of  this  pamphlet. 
t  The  bichloride  of  mercnry  should  not  be  used  stronger  than  1  to  500. 


RABIES— HYDROPHOBIA.  51 

The  Pasteur  treatment  can  be  secured  from  two  central  points  in  the 
United  States;  one  in  New  York  City,  at  the  corner  of  Central  Park  and 
Ninety-seventh  street,  and  the  other  in  Chicago,  at  65  Randolph  street. 
The  New  York  Institute  is  under  the  directorship  of  Doctor  Paul  Gibier, 
and  the  Chicago  Institute  is  directed  by  Doctor  A.  Lagorio.  The  statis- 
tics on  preceding  pages  of  this  paper  will  show  the  results  of  the  work  of 
each  institute. 

The  cost  of  treatment  is  small  compared  with  the  value  of  a  human  life. 
I  understand  that  the  charge  for  the  treatment  alone  is  ordinarily  $200.00, 
which  does  not  include  the  expense  of  living  during  the  period  of  treat- 
ment, which  lasts  about  15  days. 

When  it  is  proposed  to  send  a  patient  to  a  Pasteur  institute  it  should 
be  remembered  that  it  is  important  to  send  at  the  same  time  the  piece  of  the 
medula  oblongata  prepared  in  the  vial  of  pure  glycerine  only. 

If  the  person  suspected  of  being  infected  is  himself  able,  or  has  friends 
who  are  financially  able,  the  problem  of  securing  the  treatment  is  not 
great.  But  when  the  patient  or  his  friends  are  not  able  the  problem  is  not 
so  easy,  and  the  question  is — 

how  can  the  preventive  inoculations  be  secured? 

In  Michigan  there  is  a  law  which  provides  that  the  local  board  of 
health!  shall  see  that  no'person  sick  or  infected  with  a  disease  dangerous  to 
the  public  health  shall  suffer  for  want  of  nurses  or  other  "  necessaries," 
which  certainly  implies  that  no  person  is  to  suffer  for  want  of  medical 
attendance;  and,  as  long  as  it  is  recognized  that  Pasteur's  inocula- 
tions is  the  only  known  preventive,  no  person  should  be  permitted  to  suffer 
for  want  of  that  treatment.  This  same  statute  provides  that  the  expense 
is  chargeable  to  the  county  in  cases  where  the  patient  or  the  patient's 
friends  are  not  able.  It  is  not  at  all  improbable  that  the  expense  of  the 
Pasteur  treatment  might  be  chargeable  to  the  county  in  such  cases. 

In  Great  Britain  and  especially  in  Scotland  the  municipality  has  sent 
many  patients  to  the  Paris  Pasteur  institute;  and  in  some  cases  has  gone 
so  far  as  to  furnish  a  medical  attendant  to  accompany  the  patient.  This 
plan  could  be  employed  in  the  United  States.     4 

There  is  still  another  way  by  which  the  necessary  funds  might  be 
secured.  It  is  well  known  that  there  are  many  liberal,  wealthy  men,  who  are 
public  spirited,  and  might  loan  a  patient  the  money  to  secure  the  treat- 
ment. Then,  again,  the  funds  might  be  secured  by  means  of  the  subscrip- 
tion paper  so  commonly  used  in  the  relief  of  the  suffering. 


<gm 


m 


«o& 


fv:v 


